What is prior authorization?
Prior authorization (PA) means the insurer must approve certain care before it happens—surgery, imaging, a device, or sometimes a drug. If PA is denied, the patient usually has not received the service yet. That is different from a claim denial after care was already provided.
For a plain-language overview that applies everywhere, see Prior authorizations. This page is Arizona-only.
First step: confirm plan type — Arizona: Start Here.
Arizona PA deadlines
Arizona law (Title 20, Article 34) sets rules for health care service plans that use prior authorization. Key statute: A.R.S. § 20-3404.
How fast must the plan decide?
After the plan has all information needed to decide:
- Urgent care: notify the provider within 5 days
- Everything else (non-urgent): notify the provider within 14 days
The notice must say whether the request is approved, denied, or incomplete. If denied, the plan must give a specific reason. If incomplete, the provider can send more information; after that, the same 5-day or 14-day clock generally starts again.
If the plan misses the deadline
If the plan does not meet these rules, the PA request is treated as approved (deemed granted). That is an important advocate fact—document when the request was sent and what came back, if anything.
What plans must publish
Plans must list PA requirements on their website or provider portal, accept electronic requests, and offer at least two ways to submit (phone, fax, or electronic), including after-hours emergency procedures (A.R.S. § 20-3403).
Prescription drugs
- Formulary exceptions: 72 hours standard, 24 hours if expedited (A.R.S. § 20-3336)
- Chronic pain PA: if approved, must stay valid at least 6 months unless the plan follows specific renewal rules (A.R.S. § 20-3405)
Medical director review (starting July 1, 2026)
New law requires a medical director to personally review denials involving medical necessity before the insurer denies PA or a claim, and not rely only on automated tools (Arizona Legislature — SB 2175 summary).
Where to look up PA rules
Always match tools to the exact plan on the ID card. Major 2026 Marketplace carriers in Arizona include:
- Blue Cross Blue Shield of Arizona: azblue.com
- UnitedHealthcare: uhcprovider.com — prior auth
- Ambetter / Arizona Complete Health: azcompletehealth.com
- Cigna Healthcare: cigna.com — precertification
- Oscar Health: hioscar.com — providers
AHCCCS (Medicaid)
Medicaid PA and appeals are not governed by A.R.S. § 20-3404. Fee-for-service PA rules are in AHCCCS policy (for example AMPM Policy 820). If services are denied, members usually appeal through their health plan first, then may request a State Fair Hearing — see azahcccs.gov — grievances and appeals.
If PA is denied
- Get the denial in writing with the specific reason and appeal rights.
- Ask the treating clinician to send clinical records and a letter explaining medical necessity.
- File an appeal using the instructions on the notice—see Arizona internal appeals.
- If care cannot wait, ask for expedited review (72-hour path in Arizona law).
Building a strong appeal packet has a checklist for records and clinician letters.
Urgent and emergency care
When delay could seriously harm the patient, the doctor can request expedited medical review. The doctor must certify in writing that waiting for a normal appeal would likely cause a significant negative change in the patient's condition. The plan then has 72 hours to decide (A.R.S. § 20-2534).
True emergency care is often protected under federal law and plan rules without routine PA. For urgent framing on any plan type, see expedited appeals on the Appeals Roadmap.