Prior Authorization Guidelines & Criteria

Prior Authorization Criteria
Care1st uses clinically sound, nationally developed and accepted criteria for making medical necessity decisions. Clinical criteria utilized in decision making include, but is not limited to:
- AHCCCS Guidelines/ DDD Criteria
- MCG Guidelines
- American College of Obstetrics and Gynecology
- The American Academy of Pediatrics
- WellCare Clinical Care Guidelines (CCG’s)
- ASAM Criteria: Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions, 3rd edition
Note: There is no prior authorization for Behavioral Health Crisis Services
Disease Management Guidelines | Practice Guidelines and Preventive Health Guidelines
Care1st Home
For Members
- Find a Doctor, Hospital, Urgent Care, Pharmacy
- Member Handbook
- Prescription Drug
- Care Management Program
- Community Resources
- Member Newsletters
- Smoking Cessation
- Prior Authorization Guidelines & Criteria
- Disease Management
- Practice and Preventive Health Guidelines
- Quality Measure Results
- Notice of Privacy Practices
- Compliance/HIPAA
- Preventing Fraud
- Steps 2 Success
- What to do if you have a problem or a complaint
- Contact Us