Arizona Health Care Cost Containment System Provider Registration Form

A co payment is the amount you pay a health care provider when you receive a medical service.

Arizona health care cost containment system provider registration form.

Arizona health care cost containment system quickstart guide registration account management registration account management as provider 3 step3. Provider enrollment unit po box 25520 md 8100 phoenix az 85002. Include alien registration cards. If eligibility cannot be determined you will be sent a pre populated renewal form with a request.

1 800 654 8713 outside maricopa county. After selecting the i agree and clicking on the next button user can select the business type on the following screen. Northern arizona at 800 322 8670. Ahcccs 801 e jefferson st phoenix az 85034 find us on google maps.

This system contains state of arizona and u s. Arizona health care cost containment system application instructions. 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.

Southern arizona at 866 495 6738. Your co payment amount will vary. 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. Ahcccs stands for arizona health care cost containment system and it is the state of arizona s. 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. Arizona long term care system altcs offices.

1 800 654 8713 outside maricopa county. Central arizona at 800 564 5465. Web form cqm azahcccs gov 602 417 4885. Once the business type is selected the boxes for the corresponding.

602 417 4000 in state toll free. Alien registration cards if there are non u s. You can apply online for ahcccs medical assistance nutrition assistance and cash assistance using health e arizona plus heaplus. Individuals must meet certain income and other requirements to obtain services.

For more information contact the rbha in your area. Ahcccs 801 e jefferson st phoenix az 85034 find us on google maps. 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.