Ready for you now: Request/track prior auths via Availity portal
Good news! You can now request prior authorization via Availity Essentials™ and check status on the dashboard. This major milestone in our portal transition gives you these advantages:
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Choice of outpatient or inpatient request template
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Provider search so you don’t have to manually enter provider information
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Member eligibility check (if member is from another Blue Plan, you will be routed accordingly)
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Member-specific “Is Auth Required” response, based on the codes you enter
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Quick and easy patient record upload
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Dashboard to check status and add records (you can also “pin” other AZ Blue auths to track them on the dashboard)
To learn more about how we’re using the Availity Essentials prior auth workflow, see our recent announcement. For assistance, feel free to contact the Availity support team at 800-282-4548. To register your organization, visit Availity’s Portal Registration page.
Varicose vein treatments will require prior authorization for all commercial plans: See the codes.
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Five injectable drug codes will require prior auth for all commercial plans (not just plans delegated for EviCore): J0585 through J0589
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One code is no longer eligible for the Gold Card Program: 22840 (posterior non-segmental instrumentation)
Medical policy update:
We’re updating our MCG care guidelines to the 30th edition. We don’t have an exact date yet, but we’re targeting sometime in June. Stay tuned!
30-day readmission policy update, effective June 1:
Claims for acute care hospital readmissions that occur within 30 days after discharge are reviewed in relation to the initial hospitalization to evaluate the circumstances. Starting June 1, if the readmission is determined to be a continuation of care, and the claim is for the same DRG as the original claim, the claim for the readmission will be denied as included in the primary admission. If the claim is for a similar DRG, it will go through further review by a clinician.
Non-reimbursable modifiers: Certain modifiers indicate that an external funding source holds financial responsibility (i.e., HU, HV, HW, HX, HZ, QJ, SE, SL). AZ Blue will not reimburse for these. See the revised Modifier Pricing Action List.
Refresher on recent and upcoming changes
STARTS MAY 1
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Starting May 1, the standard timely filing time frame for Federal Employee Program® (FEP®) claims will be 90 days from the date of service. This aligns with the AZ Blue standard time frame for claim submission.
STARTED APRIL 1
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Claim payments for FEP member services are now made once a week, on Tuesdays.
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ABA prior authorization requests must include specific documentation. See what to include.
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For service dates on or after April 1, certain non-therapeutic radiopharmaceuticals and contrast agents administered during an imaging procedure or nuclear medicine procedures rendered in a facility setting will be included in the reimbursement for the associated service. See the updated Included Services list.
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The 2026 Part B step therapy list now reflects these updates:
Denosumab: Added Enoby™ and Xtrenbo™ to the step 2 (non-preferred) list of biosimilars.
Myasthenia gravis: Relaxed the step therapy requirements for certain medications and diagnoses.
Our quarterly drug fee updates are now available on the Availity Essentials portal. Read more.
OTHER REMINDERS
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The incident-to services policy was further revised in response to questions about providers reimbursed as 1099 workers. See the 03/03/26 policy revision.
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Condition code 1111F documents the completion of medication reconciliation after discharge. Please include this code on the acute-care claim or send a separate “penny code” claim (bill code 1111F at $0.01) to support compliance with the Transitions of Care (TRC) HEDIS® measure. Be sure to include the NPI of the clinician who went over all post-discharge medication protocols with the patient (and family or caregivers). This will provide a valid record for our HEDIS reporting.
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Sending us mail or a fax? Include your name, address, and phone and fax numbers so we can process your request.
Learning opportunities
Perinatal mental health: Designed to support maternal mental health in Arizona, this free, self-paced training takes you through three one-hour modules to help you deliver compassionate, effective care to this vulnerable population. See course and CE information.
Availity is a separate, independent company contracted with AZ Blue for provider portal services. Availity is a registered service mark and Availity Essentials is a service mark of Availity, LLC.
The MCG care guidelines are the proprietary and copyright-protected information of MCG Health, part of the Hearst Health network.
Enoby and Xtrenbo are trademarks of Hikma Pharmaceuticals USA Inc.
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.
