Arizona Health Care Cost Containment System Provider Registration Form

Web form cqm azahcccs gov 602 417 4885.

Arizona health care cost containment system provider registration form. Collect money we overpaid to you in the form of benefits. Alien registration cards if there are non u s. This information is confidential under state and federal law. This system contains state of arizona and u s.

Include alien registration cards. 602 417 4000 in state toll free. Arizona health care cost containment system quickstart guide registration account management registration account management as provider 3 step3. 1 800 654 8713 outside maricopa county.

602 417 4000 in state toll free. After selecting the i agree and clicking on the next button user can select the business type on the following screen. Your co payment amount will vary. For more information contact the rbha in your area.

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. Citizens applying for benefits in your household. Apply personally at a local faa office at the department of economic security des office at the hospital or at certain clinics.

Arizona health care cost containment system application instructions. Arizona long term care system altcs offices. Southern arizona at 866 495 6738. Ahcccs 801 e jefferson st phoenix az 85034 find us on google maps.

Use and disclosure of this information is limited to purposes directly related to the administration of the arizona health care cost containment system. Arizona health care cost containment system ahcccs is arizona s medicaid agency that offers health care programs to serve arizona residents. You may use only one application form to apply for everyone in your family. Provider enrollment unit po box 25520 md 8100 phoenix az 85002.

Once the business type is selected the boxes for the corresponding. 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. If eligibility cannot be determined you will be sent a pre populated renewal form with a request.

General administration questions other contacts. Northern arizona at 800 322 8670. 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.