If eligibility cannot be determined you will be sent a pre populated renewal form with a request.
Arizona health care cost containment system provider registration form.
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.
A co payment is the amount you pay a health care provider when you receive a medical service.
Use and disclosure of this information is limited to purposes directly related to the administration of the arizona health care cost containment system.
General administration questions other contacts.
1 800 654 8713 outside maricopa county.
602 417 4000 in state toll free.
Your co payment amount will vary.
For more information contact the rbha in your area.
After selecting the i agree and clicking on the next button user can select the business type on the following screen.
You may use only one application form to apply for everyone in your family.
Ahcccs 801 e jefferson st phoenix az 85034 find us on google maps.
Arizona health care cost containment system quickstart guide registration account management registration account management as provider 3 step3.
Ahcccs stands for arizona health care cost containment system and it is the state of arizona s.
Web form cqm azahcccs gov 602 417 4885.
602 417 4000 in state toll free.
1 800 654 8713 outside maricopa county.
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.
This system contains state of arizona and u s.
Arizona health care cost containment system application instructions.
You can apply online for ahcccs medical assistance nutrition assistance and cash assistance using health e arizona plus heaplus.
Arizona long term care system altcs offices.
Alien registration cards if there are non u s.
Southern arizona at 866 495 6738.
This information is confidential under state and federal law.
Once the business type is selected the boxes for the corresponding.
Apply personally at a local faa office at the department of economic security des office at the hospital or at certain clinics.
Citizens applying for benefits in your household.
Northern arizona at 800 322 8670.
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 attn.
