Prior Authorization Correction Form

The Prior Authorization Correction Form is to be utilized to request changes to an existing Prior Authorization. Any additional medical documentation for this request should be submitted with this request. The form must be completed in its entirety.

Prior Authorization Correction Form [PDF, 87KB]

Contacts

You may phone or fax the AHCCCS Prior Authorization Unit to request authorization.

To obtain a prior authorization by telephone, providers must call Monday through Friday between 9am to 11:30am, and 12:30pm to 4pm.

• Within Maricopa County: 602-417-4400, Select option 1 for transportation
• Statewide: 1-800-433-0425
• Outside Arizona: 1-800-523-0231
• FESP Dialysis: 602-417-7548

The AHCCCS Prior Authorization Unit's fax number is 602-256-6591.

Allow at least three working days for your request to be processed.