Arizona Health Care Cost Containment System Provider Registration Form

Alien registration cards if there are non u s.

Arizona health care cost containment system provider registration form.

Ahcccs stands for arizona health care cost containment system and it is the state of arizona s. Southern arizona at 866 495 6738. Ahcccs 801 e jefferson st phoenix az 85034 find us on google maps. General administration questions other contacts.

Arizona health care cost containment system quickstart guide registration account management registration account management as provider 3 step3. Apply personally at a local faa office at the department of economic security des office at the hospital or at certain clinics. This information is confidential under state and federal law. Your co payment amount will vary.

Use and disclosure of this information is limited to purposes directly related to the administration of the arizona health care cost containment system. 1 800 654 8713 outside maricopa county. Once the business type is selected the boxes for the corresponding. Arizona health care cost containment system application instructions.

You may use only one application form to apply for everyone in your family. Arizona long term care system altcs offices. Arizona health care cost containment system ahcccs is arizona s medicaid agency that offers health care programs to serve arizona residents. 602 417 4000 in state toll free.

1 800 654 8713 outside maricopa county. You can apply online for ahcccs medical assistance nutrition assistance and cash assistance using health e arizona plus heaplus. If eligibility cannot be determined you will be sent a pre populated renewal form with a request. Central arizona at 800 564 5465.

Provider enrollment services available online arizona health care cost containment system ahcccs is arizona s medicaid agency that offers health care programs to serve arizona residents. After selecting the i agree and clicking on the next button user can select the business type on the following screen. Individuals must meet certain income and other requirements to obtain services. This system contains state of arizona and u s.

602 417 4000 in state toll free. A co payment is the amount you pay a health care provider when you receive a medical service. Collect money we overpaid to you in the form of benefits. Include alien registration cards.

Provider enrollment unit po box 25520 md 8100 phoenix az 85002. Northern arizona at 800 322 8670. Arizona health care cost containment system ahcccs attn. Web form cqm azahcccs gov 602 417 4885.