AHCCCS providers of health care services may file a Claim Dispute to challenge payments or denials of claims. The request for a claim dispute should indicate the facts and the relief requested.
All claim disputes must be filed in writing, within the following timelines:
For claim disputes involving a Fee-For-Service (FFS) member, the written dispute must be filed with the Office of the General Counsel (OGC).Appeals
For questions concerning a Fee-For-Service claim dispute:
For claim disputes involving enrolled members, the written dispute must be filed with the member's health plan.
After a claim dispute review is completed, a Notice of Decision will be issued. If the Notice of Decision is unfavorable, the provider has 30 days from receipt of the notice to request a state fair hearing.