Arizona Health Care Cost Containment System Provider Registration Form

Arizona health care cost containment system ahcccs is arizona s medicaid agency that offers health care programs to serve arizona residents.

Arizona health care cost containment system provider registration form.

You can apply online for ahcccs medical assistance nutrition assistance and cash assistance using health e arizona plus heaplus. 1 800 654 8713 outside maricopa county. A co payment is the amount you pay a health care provider when you receive a medical service. For more information contact the rbha in your area.

You may use only one application form to apply for everyone in your family. 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.

Include alien registration cards. 602 417 4000 in state toll free. Provider enrollment unit po box 25520 md 8100 phoenix az 85002. Individuals must meet certain income and other requirements to obtain services.

1 800 654 8713 outside maricopa county. Ahcccs 801 e jefferson st phoenix az 85034 find us on google maps. This system contains state of arizona and u s. Use and disclosure of this information is limited to purposes directly related to the administration of the arizona health care cost containment system.

Once the business type is selected the boxes for the corresponding. Ahcccs stands for arizona health care cost containment system and it is the state of arizona s. Arizona health care cost containment system quickstart guide registration account management registration account management as provider 3 step3. Arizona health care cost containment system ahcccs attn.

602 417 4000 in state toll free. Alien registration cards if there are non u s. Arizona long term care system altcs offices. Citizens applying for benefits in your household.

Northern arizona at 800 322 8670. Arizona health care cost containment system application instructions. 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. Ahcccs 801 e jefferson st phoenix az 85034 find us on google maps.

Web form cqm azahcccs gov 602 417 4885. Collect money we overpaid to you in the form of benefits. General administration questions other contacts. If eligibility cannot be determined you will be sent a pre populated renewal form with a request.