You are invited to participate in a survey regarding your experience using the AHCCCS
website. This survey will take approximately two minutes. Your responses will help
us ensure that you have a high quality experience.
The Prior Authorization Request Form is to be completed by registered providers to request an initial authorization. Providers should submit any medical documentation
needed for the authorization to be considered with this form. The form must be completed
in its entirety.
Authorization Request Form [PDF, 89KB]
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.
The AHCCCS Prior Authorization Unit's fax number is 602-256-6591.
Allow at least three working days for your request to be processed.