Arizona Health Care Cost Containment System Provider Registration Form

602 417 4000 in state toll free.

Arizona health care cost containment system provider registration form.

General administration questions other contacts. This information is confidential under state and federal law. Collect money we overpaid to you in the form of benefits. You may use only one application form to apply for everyone in your family.

Arizona health care cost containment system ahcccs attn. A co payment is the amount you pay a health care provider when you receive a medical service. 1 800 654 8713 outside maricopa county. 602 417 4000 in state toll free.

If eligibility cannot be determined you will be sent a pre populated renewal form with a request. 1 800 654 8713 outside maricopa county. Central arizona at 800 564 5465. Your co payment amount will vary.

Southern arizona at 866 495 6738. Apply personally at a local faa office at the department of economic security des office at the hospital or at certain clinics. Web form cqm azahcccs gov 602 417 4885. Ahcccs 801 e jefferson st phoenix az 85034 find us on google maps.

For more information contact the rbha in your area. Individuals must meet certain income and other requirements to obtain services. Include alien registration cards. 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 long term care system altcs offices. This system contains state of arizona and u s. Arizona health care cost containment system application instructions.

Alien registration cards if there are non u s. Ahcccs 801 e jefferson st phoenix az 85034 find us on google maps. 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. Citizens applying for benefits in your household.

You can apply online for ahcccs medical assistance nutrition assistance and cash assistance using health e arizona plus heaplus. Northern arizona at 800 322 8670. After selecting the i agree and clicking on the next button user can select the business type on the following screen. Provider enrollment unit po box 25520 md 8100 phoenix az 85002.