Banner Medicare Advantage has long-standing contracts with the Centers for Medicare and Medicaid. Effective January 1, 2026, the Banner Medicare Advantage Prime HMO will reduce its service areas in Pima, Pinal, Santa Cruz and Yuma counties. Members impacted by this change will be notified by October 1, 2025, that their plan is ending 12/31/25.
As part of our ongoing commitment to provide care and coverage for our members, we will focus exclusively on Maricopa County. We will continue to offer our members a comprehensive and integrated care approach for Medicare coverage benefits, including hospitals, providers and prescriptions to address healthcare needs.
The reduction of the Banner Medicare plan’s service area in Pima, Pinal, Santa Cruz and Yuma counties will not impact your current provider agreements.
Banner Health will continue to offer and administer the Banner Medicare Advantage Dual (D-SNP plans) in Cochise, Gila, Graham, Greenlee, La Paz, Maricopa, Pima, Pinal, Santa Cruz and Yuma counties (our current CY2025 footprint.)
Banner requests your assistance and cooperation to:
If you have any questions, please reach out to Care Transformation or the Provider Experience Center by phone at 1-844-549-1857.
UPDATE (1/24/2025) - The fax system outage described below is now resolved.
Banner – University Family Care (ACC and ALTCS) and Banner Medicare Advantage (DUAL and HMO) are currently experiencing a fax system outage for pharmacy benefit requests only.
Medical benefit prior authorization requests (including for drugs administered through the medical benefit) are not impacted.
Any faxes sent to our pharmacy benefit prior authorization team using the number listed on the pharmacy prior authorization form (833-812-0181 or 833-951-1682) since Wednesday, 1/15/2025, at 4PM Arizona Time have not been received by the plan even if the fax appeared to succeed.
Until further notice, use 833-329-5135 for fax communications related to pharmacy benefit prior authorizations.
Please re-send any faxes related to pharmacy benefit prior authorizations that have been sent after 4pm Arizona Time on Wednesday, 1/15/2025.
For medical benefit authorizations (including drugs requested through the medical benefit), no action is needed. Please continue to use the number listed on the Medical Prior Authorization Form.
Other options to submit a pharmacy benefit prior authorization
In compliance with the Centers for Medicare & Medicaid Services (CMS) effective January 1, 2024, Banner Medicare Advantage will provide new members up to a 90-day transition period when a member is undergoing an active course of treatment and switches from a previous Medicare Advantage plan or Medicare Fee for Service to a Banner Medicare Advantage plan.
If a member has newly enrolled with Medicare and joins a Banner Medicare Advantage plan, the transition policy will also apply. The option to request extended coverage up to 90 days from their previous benefit, out-of-network health care professional at network rates for a limited time due to a specific medical condition, until the safe transfer to a network health care professional can be arranged. BMA members may submit a Continuity of Care form by visiting Banner Medicare Advantage - Continuity of Care Form.
Effective 4/01/22, providers have a new process with eviCore for requesting prior authorization.
The eviCore provider portal is experiencing technical difficulty, some members and/or facilities are not populating within the portal. Providers will need to call in their requests while eviCore works to resolve.
Rad/Card requests – (888) 693-3211 & Rad Therapy/Med Onc/MSK Requests – (888) 444-9261
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