Healthcare Management General Information
HCM Contact Information
HCM Clinical Review Criteria AR CODE #14220, A.C.A. 23-99-1105(a)
HCM Utilization Management Program Description
Clinical Guidelines
Clinical Criteria (Password Required) AR CODE #14220, A.C.A. 23-99-1105(a)
Clinical Guideline Library CA CODE #30219, 10144.52(e)
Introduction to Evidence-Based Clinical Review Criteria & Mental Health Parity CA CODE #30219, 10144.52(e)
Introduction to Clinical Review Criteria
ASAM Criteria
Plan Precertification Requirements
HCM Precertification List & Options
Forms
State Pre-authorization Forms
AZ Standard Prior Authorization Form for Health Care Services § AZ Stat 20-2534
AZ Standard Prior Authorization Form for Medication, DME and Medical Devices § AZ Stat 20-2534
California: Prescription Drug Prior Authorization or Step Therapy Exception Form CA CODE #19367, 10 CCR § 2218.30(d)
Texas Standard Prior Authorization Request Form TX CODE 13275, 28 TAC 19.1810(d)
Texas Prescription Drugs Prior Authorization Request Form TX CODE 14099, 28 TAC 19.1820(d)