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BCBSAZ uses evidence-based clinical criteria to determine benefit coverage for a member’s specific health condition. See below for instructions about accessing our medical policies.
Policies applicable to most BCBSAZ plans (see exceptions below)
eviCore clinical guidelines (for certain specialty services and drugs) – Access our eviCore resource page.
InterQual® criteria (for many services) – Access BCBSAZ criteria through the secure provider portal at “Practice Management > Clinical Criteria > BCBSAZ Members-InterQual® search.” Or call the number on the back of the member ID card.
BCBSAZ proprietary medical policies – Access our evidence-based criteria search tool.
Chiropractic clinical practice guidelines – Access the American Specialty Health (ASH) provider resource page.
Pharmacy coverage guidelines (for drugs covered under pharmacy benefits) – Access our pharmacy resource page.
Exceptions
BCBSAZ-administered Medicare Advantage plans
BlueCard® (Out-of-Area) plans – Access information from other BCBS Plans through the secure provider portal at “Practice Management > Medical Policies > BlueCard (Out of-Area) Members"
Federal Employee Program® (FEP®) plans – Go to FEPblue.org > Policies & Guidelines
CHS group plans – Contact the group’s third-party administrator (TPA) listed on the back of the member ID card.
BCBSAZ/TPA co-administered group plans – See the reference list for clinical criteria information.
eviCore healthcare is a separate, independent company that offers utilization management services to BCBSAZ members and providers. eviCore healthcare is a registered service mark of CareCore National, LLC.
InterQual® is a registered trademark of Change Healthcare LLC and/or one of its subsidiaries.
BCBSAZ contracts with ASH, a separate, independent company, to provide the chiropractic network, covered chiropractic services, and related claim processing and appeal/grievance resolution.
The MCG care guidelines are the proprietary and copyright-protected information of MCG Health, LLC, part of the Hearst Health network.
