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 provider registration form.
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.
This system contains state of arizona and u s.
If eligibility cannot be determined you will be sent a pre populated renewal form with a request.
Apply personally at a local faa office at the department of economic security des office at the hospital or at certain clinics.
You may use only one application form to apply for everyone in your family.
Arizona health care cost containment system application instructions.
Arizona health care cost containment system quickstart guide registration account management registration account management as provider 3 step3.
Central arizona at 800 564 5465.
A co payment is the amount you pay a health care provider when you receive a medical service.
Collect money we overpaid to you in the form of benefits.
This information is confidential under state and federal law.
Southern arizona at 866 495 6738.
After selecting the i agree and clicking on the next button user can select the business type on the following screen.
602 417 4000 in state toll free.
Alien registration cards if there are non u s.
1 800 654 8713 outside maricopa county.
Arizona health care cost containment system ahcccs attn.
Include alien registration cards.
Provider enrollment unit po box 25520 md 8100 phoenix az 85002.
Ahcccs 801 e jefferson st phoenix az 85034 find us on google maps.
Ahcccs 801 e jefferson st phoenix az 85034 find us on google maps.
Arizona health care cost containment system ahcccs is arizona s medicaid agency that offers health care programs to serve arizona residents.
Web form cqm azahcccs gov 602 417 4885.
For more information contact the rbha in your area.
Northern arizona at 800 322 8670.
Ahcccs stands for arizona health care cost containment system and it is the state of arizona s.
Citizens applying for benefits in your household.
Arizona long term care system altcs offices.
Your co payment amount will vary.
602 417 4000 in state toll free.
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.
