This fully loaded version of the tool includes the prior auth requirements for most individual and employer group plans, as well as Federal Employee Program® (FEP®) and Medicare Advantage plans. How the tool can help:
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Returns more member-specific results
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Includes replacements for termed codes
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Indicates site-of-service requirements
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Flags the codes included in the Gold Card Program
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Offers routing information for third-party prior auth administrators
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When applicable, links to EviCore for your auth request
NPPES data is a trusted data source: Is yours up to date?
When was the last time you checked your data in the NPPES data registry at nppes.cms.hhs.gov? Here are some reasons why it’s important to keep it current, especially your address and taxonomy (specialty) information:
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Payers may reference NPPES data as the source of truth in claim processing – if the claim data doesn’t match what’s in your NPPES record, the claim may be denied.
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NPPES data is used to improve provider directory accuracy – discrepancies between NPPES and payer data may result in a provider not being displayed in the directory.
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Taxonomy codes have become standard to confirm provider qualifications and specialties.
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Billing organizations must have a Type 2 (organization) NPI to avoid claim denials.
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With more interoperability requirements on the horizon, accurate NPPES data is critical.
Other news and reminders
Medical policy update: We have updated our Bioengineered Skin and Soft Tissue Substitutes policy to clarify that AlloMend® is considered experimental/investigational for breast reconstructive surgery. For details, see the updated policy, effective for service dates on or after November 1, 2025.
The quarterly drug fee updates (effective October 1) are now available to preview. Get the details.
You can validate eligibility without an ID card: Did you know you can check eligibility without an ID card? It’s easy on the Availity portal—just search with the patient’s member ID and date of birth, and you’ll get the current status with all the details. You can also download AZ Blue member ID cards and save a copy to your patient file.
Substance Use Disorders (SUDs): Every first Monday, noon-1 p.m.
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Trauma in Children (TIC): Every second Monday, noon-1 p.m.
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Complex Care (CC): Every third Monday, noon-1 p.m.
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Take advantage of this powerful 5.5 CME course offered by the American College of Lifestyle Medicine (ACLM): You can access the award-winning “Essentials” course bundle online at no cost. Register with promo code ESS-BCBSAZ to get the 5.5 CME/CE credits free of charge.
Blue Cross, Blue Shield, the Cross and Shield Symbols, Federal Employee Program, and FEP are registered service marks of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans.
AlloMend is a registered trademark of AlloSource.
Availity is a separate, independent company contracted with AZ Blue for provider portal services. Availity and Availity Essentials are registered trademarks of Availity, LLC.
Mountain Echo Academy is a Project Echo® replicate. Project Echo is a registered trademark of UNM Rainforest Innovations.
American Diabetes Association is a trademark of American Diabetes Association, Inc.
