Uniform prior authorization request forms; definition

A.R.S. § 20-3406 — under General Provisions.

A.R.S. § 20-3406

1. Not exceed two printed pages. This two-page limit does not apply to or include a provider's notes or documentation that the provider submits in support of a prior authorization request.

2. Meet the electronic submission and acceptance requirements prescribed in section 20-3403.

B. In approving the uniform prior authorization request forms, the department shall both:

1. Consider the following:

(a) Any existing prior authorization request forms that the centers for medicare and medicaid services or the United States department of health and human services has developed.

(b) Any national standards relating to electronic prior authorization.

(c) Any other form adopted by the director or another state agency.

2. Seek input from interested stakeholders, including providers, health care services plans, utilization review agents, pharmacists and pharmacy benefit managers.

C. This section does not prohibit a payor or any entity acting for a payor under contract with the payor from using a prior authorization methodology that uses an internet webpage, an internet webpage portal or a similar electronic, internet and web-based system if the methodology is consistent with the uniform prior authorization request forms approved by the director pursuant to this section.

D. For the purposes of this section, "provider" includes a health professional as defined in section 32-3218 or a health care institution that is licensed under title 36.