Good news about prior auth codes and other clinical updates
Effective December 15, 2025: Over 300 codes will be removed from our commercial prior authorization requirements lists (including the standard list and the custom lists for the State of Arizona and Teamsters employer groups) and over 200 codes from the Medicare Advantage requirements. Preview a draft of the updated code lists.
Effective for service dates on and after January 1, 2026:
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This list of drugs will require prior approval for FEP plans. These drugs are currently reviewed post-service (pre-payment) for medical necessity.
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Code 33285 (insertion, subcutaneous cardiac rhythm monitor, including programming) will require prior authorization for commercial plans.
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Code G9012 (other specified case management service not elsewhere classified) will no longer be allowed when billed with applied behavior analysis (ABA) therapy codes for commercial plans.
2026 Provider Operating Guide: The preview period for the 2026 Provider Operating Guide begins December 1. You can find the Guide on the AZ Blue provider portal at “Provider Resources > Provider Guidelines > Provider Operating Guide.” Meanwhile, you can take a look at a summary of notable changes or the detailed Appendix of Changes.
Quarterly drug fee updates: The January 1 updates will be available to preview by December 1. Get the details.
Standard timely filing moves to 90 days: Effective for claims with service dates on or after January 1, 2026, our standard timely filing time frame will be 90 days from the date of service. Claims submitted more than 90 days from the service date will be denied for untimely filing.
Making it easy with claims fax lines consolidation: Starting January 1, you’ll only need these four fax lines for most business related to claims (see the full fax line consolidation list for details):
Code edit update for procedure code H0004 (Behavioral Health Counseling and Treatment per 15 min): Effective for commercial and FEP claims with service dates on or after January 1, the limit for a single date of service will change from 50 units to 32 units.
ACA plans for 2026: We’re discontinuing the MaricopaFocus and PimaFocus networks for 2026. All of our individual/family plans will be supported by the following networks:
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New!Focus Network – HMO plans for members residing in Maricopa, Gila, Pima, Pinal, and Santa Cruz counties
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Neighborhood Network – HMO plans for members residing outside of Maricopa, Gila, Pima, Pinal, and Santa Cruz counties
Availity provider portal transition: We’ll be completing our transition to the Availity Essentials™ provider portal in early 2026. At that point the AZ Blue provider portal will be sunset. Be sure your teams all have Availity portal accounts. To get started, visit availity.com/azblue.
Other recent and upcoming changes
Started November 1:
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Most commercial claims denied for failure to send requested medical records will no longer be reprocessed if records are received later than one year after the denial date.
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The EviCore prior authorization request process for Gold Card Program providers requires records (reviewed only if/when audited). Also, the applied behavior analysis (ABA) therapy codes that require prior authorization are no longer eligible for the Gold Card Program.
Starting December 1, 2025: The ProviderGrievance@azblue.com email inbox will be closing. You can still fax provider grievances to 602-544-5601 or mail them to PO Box 13466, Phoenix, AZ 85002.
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.
Availity is a separate, independent company contracted with AZ Blue for provider portal services. Availity and Availity Essentials are registered trademarks of Availity, LLC.
AlloMend is a registered trademark of AlloSource.
Durolane and Gelsyn-3 are registered trademarks of Bioventus LLC.
Euflexxa is a registered trademark of Ferring BV.
Supartz FX is a registered trademark of Seikagaku Kogyo Kabushiki Kaisha (Seikagaku Corp.).
