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.

Alien registration cards if there are non u s. This system contains state of arizona and u s. This information is confidential under state and federal law. Citizens applying for benefits in your household.

Provider enrollment unit po box 25520 md 8100 phoenix az 85002. Include alien registration cards. 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.

A co payment is the amount you pay a health care provider when you receive a medical service. Ahcccs 801 e jefferson st phoenix az 85034 find us on google maps. If eligibility cannot be determined you will be sent a pre populated renewal form with a request. Arizona long term care system altcs offices.

Ahcccs stands for arizona health care cost containment system and it is the state of arizona s. 1 800 654 8713 outside maricopa county. Web form cqm azahcccs gov 602 417 4885. Arizona health care cost containment system ahcccs attn.

For more information contact the rbha in your area. You can apply online for ahcccs medical assistance nutrition assistance and cash assistance using health e arizona plus heaplus. Your co payment amount will vary. Southern arizona at 866 495 6738.

Collect money we overpaid to you in the form of benefits. Central arizona at 800 564 5465. 602 417 4000 in state toll free. Use and disclosure of this information is limited to purposes directly related to the administration of the arizona health care cost containment system.

You may use only one application form to apply for everyone in your family. After selecting the i agree and clicking on the next button user can select the business type on the following screen. 602 417 4000 in state toll free. Individuals must meet certain income and other requirements to obtain services.

General administration questions other contacts. Once the business type is selected the boxes for the corresponding. Northern arizona at 800 322 8670. Arizona health care cost containment system application instructions.