Plans/Providers

Provider Claim Disputes

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.

Requirements for Filing a Claim Dispute

All claim disputes must be filed in writing, within the following timelines:

• Within twelve months after the date of service
• Within twelve months after the date that eligibility is posted or
• Within sixty days after the date of the denial of a timely claim submission, whichever is later

All claim disputes must comply with the requirements of Arizona Revised Statutes (A.R.S. 36-2903.01.B.4) and Arizona Administrative Code (A.A.C. R9-34-401 et seq.)

Filing a Claim Dispute Involving Fee-For-Service Members

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
Office of the General Counsel
MD6200
801 E. Jefferson
Phoenix, AZ 85034
Fax: (602) 253-9115

For questions concerning a Fee-For-Service claim dispute:

Call:

• Within Maricopa County 602-417-4232
• Statewide 1-800-654-8713 ext. 74232

Notice of Decision

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.