Arizona Health Care Cost Containment System Provider Registration Form

Ahcccs 801 e jefferson st phoenix az 85034 find us on google maps.

Arizona health care cost containment system provider registration form. Arizona health care cost containment system application instructions. For more information contact the rbha in your area. Web form cqm azahcccs gov 602 417 4885. 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. 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. Collect money we overpaid to you in the form of benefits.

Include alien registration cards. 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. Northern arizona at 800 322 8670.

Once the business type is selected the boxes for the corresponding. 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. This system contains state of arizona and u s.

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. Provider enrollment unit po box 25520 md 8100 phoenix az 85002. After selecting the i agree and clicking on the next button user can select the business type on the following screen.

Alien registration cards if there are non u s. Central arizona at 800 564 5465. 602 417 4000 in state toll free. This information is confidential under state and federal law.

Your co payment amount will vary. Arizona long term care system altcs offices. 602 417 4000 in state toll free. General administration questions other contacts.

Arizona health care cost containment system ahcccs is arizona s medicaid agency that offers health care programs to serve arizona residents. Southern arizona at 866 495 6738. 1 800 654 8713 outside maricopa county. Citizens applying for benefits in your household.