Covered Services: Prior Authorizations and Referrals

As a member of B – UFC/ACC, you are eligible for a wide array of health care benefits. Your benefits include behavioral health services and some dental. The list below does not include all possible services. All covered services are funded under contract with AHCCCS. All services for B – UFC/ACC members are furnished in amount, duration, and scope for the same services furnished to members under FFS Medicaid. Your PCP may provide these services, or they may make plans for you to get these services from another provider (sometimes called a specialist) by creating a referral.

You do not need a referral from your PCP for the following services: 

  • Emergency services
  • Behavioral health services
  • OB/GYN services
  • Dental services
  • Family planning services and supplies 

Members with special health care needs may have direct access to specialists who can help provide the care you need. For help in finding a specialist, talk with your PCP or call our Customer Care Center.

 

Services that require prior authorization include:

  • Some Behavioral Health Services
    • Out of Network
    • Inpatient Facility
    • Behavioral Health Residential Facility
    • Psychological and Neuropsychological Testing
    • Electroconvulsive Therapy (ECT)
  • Inpatient hospital services
    • Planned, non-emergency admissions
    • Non-emergency Out of Network admissions
    • Surgeries, pre-scheduled
  • Some medical equipment and supplies
    • DME/electric equipment
    • Prosthetics and orthotics
  • Special lab work
    • Genetics
  • Some scans and Imaging
    • MRI, MRA
    • PET Scans
  • Some Medications
  • Dialysis
  • Some Outpatient procedures and surgeries
    • Some cosmetic procedures
  • Non-emergency out of network services and treatments
  • Certain advanced dental services

If you have any questions about these services or if you would like to discuss options to address your needs, please call our Customer Care Center so we can discuss your options. Contact your PCP to check if a service or medication needs a prior authorization. 

Please review your Member Handbook for services requiring prior approval. 

Criteria that decisions are based on are available upon request.