Common use of PRIOR AUTHORIZATION AND UTILIZATION MANAGEMENT Clause in Contracts

PRIOR AUTHORIZATION AND UTILIZATION MANAGEMENT. If the Subcontractor is a provider, the Subcontractor shall obtain Prior Authorization as required by the Subcontract and AHCCCS Rules and Policies (for members enrolled with a contracted MCO) or AHCCCS Rules and Policies (for members not enrolled with an MCO). In addition, the Subcontractor must cooperate with Utilization Management processes established by the Subcontract and AHCCCS’ Rules and Policies.