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
- InterQual Guidelines
- American College of Obstetrics and Gynecology
- The American Academy of Pediatrics
- WellCare Clinical Care Guidelines (CCG’s)
- CMS Guidelines
- 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
