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Health Choice Arizona, Inc. fax number

(877) 422-8120

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Medical Prior Authorization

Used for: Medical prior authorization submissions

Fax destination details

Department
Medical Prior Authorization
Purpose
Medical prior authorization submissions
Form
Medical Services Prior Authorization Form — Medical Services Prior Authorization Form

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Requests for prior authorization can be submitted via the Prior Authorization form through the secure provider portal or by fax to the Medical PA Fax Line. Include complete diagnosis and procedure codes, and any required medical documentation.

Review official form instructions

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