Prior Authorization Guidelines & Criteria

• Prior Authorization Guidelines
  (Effective January 1, 2012)

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
• Milliman Care Guidelines
• Official Disability Guidelines (ODG)
• American College of Obstetrics and Gynecology
• The American Academy of Pediatrics
• CMS Guidelines
• Care1st Guidelines

• Enteral Nutrition Therapy
• Mobile Cardiac Outpatient Telemetry (MCOT)
• Computed Tomography Angiography (CTA)
• Use of Computed Tomography for Evaluation of Nasal Septum Deviation
• Positron Emission Tomography (PET) for Evaluation of Fever of Unknown Origin (FUO)
• 3D Fetal Ultrasonography

Disease Management Guidelines | Practice Guidelines and Preventive Health Guidelines