Arizona Health Care Cost Containment System Provider Registration Form

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 provider registration form.

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. Citizens applying for benefits in your household. Alien registration cards if there are non u s.

Northern arizona at 800 322 8670. A co payment is the amount you pay a health care provider when you receive a medical service. 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 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 application instructions. 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. Collect money we overpaid to you in the form of benefits.

For more information contact the rbha in your area. Southern arizona at 866 495 6738. Include alien registration cards. 602 417 4000 in state toll free.

Central arizona at 800 564 5465. Arizona health care cost containment system ahcccs attn. General administration questions other contacts. Provider enrollment unit po box 25520 md 8100 phoenix az 85002.

Individuals must meet certain income and other requirements to obtain services. You may use only one application form to apply for everyone in your family. Once the business type is selected the boxes for the corresponding. This information is confidential under state and federal law.

Web form cqm azahcccs gov 602 417 4885. Your co payment amount will vary. You can apply online for ahcccs medical assistance nutrition assistance and cash assistance using health e arizona plus heaplus. Use and disclosure of this information is limited to purposes directly related to the administration of the arizona health care cost containment system.

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