Magellan Health

For Providers

Prescriber Protocols

Prior authorization process

Maricopa County Medicaid Pharmacy Program
Behavioral health medical practitioners may request prior authorization by fax (or by phone for urgent requests), using the following process:

  1. Review the formulary and the prior authorization criteria.
  2. Complete one of the prior authorization request forms below in the Prior Authorization Request Form section.
  3. Fax the completed prior authorization request form to (866) 498-0628.
  4. For urgent requests, call the Pharmacy Help Desk at (800) 790-1631.
  5. You will be notified of the initial decision as quickly as possible and no later than 24 business hours.
  6. If the request is not approved, the consumer will receive a notice of action on how to appeal the decision if needed.

Prior authorization criteria

Effective Jan. 1, 2014, Magellan will utilize the state-wide ADHS/DBHS prior authorization criteria for both Title XIX/XXI and Non-Title XIX SMI recipients. To access the new new DBHS State-Wide Prior Authorization Criteria effective Jan. 1, 2014, please visit http://www.azdhs.gov/bhs/drug-list-prior-authorization-guidelines.php

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Contact Information

Mercy Maricopa Integrated Care (Mercy Maricopa) is now the Regional Behavioral Health Authority (RBHA) serving members in the Maricopa County Region. For questions regarding your services, please call 1-800-564-5465 or TDD/TTY 711.

** To file a grievance or appeal for services provided on or before March 31, 2014 please call Magellan Health Services 602-652-5907, x8590