Arizona Health Care Cost Containment System Provider Registration Form

Central arizona at 800 564 5465.

Arizona health care cost containment system provider registration form.

602 417 4000 in state toll free. Alien registration cards if there are non u s. You may use only one application form to apply for everyone in your family. 1 800 654 8713 outside maricopa county.

Apply personally at a local faa office at the department of economic security des office at the hospital or at certain clinics. Include alien registration cards. Arizona health care cost containment system quickstart guide registration account management registration account management as provider 3 step3. A co payment is the amount you pay a health care provider when you receive a medical service.

This information is confidential under state and federal law. For more information contact the rbha in your area. Once the business type is selected the boxes for the corresponding. Arizona long term care system altcs offices.

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. 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.

Ahcccs stands for arizona health care cost containment system and it is the state of arizona s. Ahcccs 801 e jefferson st phoenix az 85034 find us on google maps. Web form cqm azahcccs gov 602 417 4885. 602 417 4000 in state toll free.

Northern arizona at 800 322 8670. Provider enrollment unit po box 25520 md 8100 phoenix az 85002. Arizona health care cost containment system application instructions. 1 800 654 8713 outside maricopa county.

Use and disclosure of this information is limited to purposes directly related to the administration of the arizona health care cost containment system. Citizens applying for benefits in your household. After selecting the i agree and clicking on the next button user can select the business type on the following screen. Individuals must meet certain income and other requirements to obtain services.

Your co payment amount will vary. Collect money we overpaid to you in the form of benefits. Ahcccs 801 e jefferson st phoenix az 85034 find us on google maps. If eligibility cannot be determined you will be sent a pre populated renewal form with a request.