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  • Advantage Prior Authorization Form - Bridgeway Health Solutions

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Prior Authorization Request Form PLEASE PRINT Complete this form and call or fax to the number listed under the logo. Note any information left blank or illegible may delay the review process. Use.

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Counseling, substance abuse counseling, and other treatments are covered. Medication Management. Special Health Care Needs Care Coordination.

Arizona Complete Health offers health insurance plans that fit your unique needs, and those of your family. Program eligibility depends on your age, income, family size and any special health needs you may have. View all of our health insurance plans available below. Select the program you are enrolled with.

Arizona Complete Health-Complete Care Plan is an integrated health plan for members served by Arizona's Medicaid program, the Arizona Health Care Cost Containment System (AHCCCS). As an integrated plan, our health plan covers both your physical and behavioral health benefits.

The member does not require a referral from the PCP to see a behavioral health medical provider. Members who are AHCCCS eligible and are also American Indian may access behavioral health services through the Tribal Regional Behavioral Health Authority (TRBHA) or Indian Health Service Facilities.

Located in Tempe, Arizona, Bridgeway is a managed care organization and is wholly owned by Centene Corporation (“Centene”).

No Referrals Needed Paper referrals are not required to direct a member to a specialist within our participating network of providers. All out of network services (excluding ER and family planning) require prior authorization.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232