Filing Process for AHCCCS Members Not Enrolled in a Health Plan

Members not enrolled in an AHCCCS Health Plan, including those who receive benefits through fee-for-service and/or those enrolled in the American Indian Health Plan (AIHP), have the right to file a grievance, make a complaint, or file an appeal. To learn more about the process, select one of the following:

• Process to File a Grievance or Make a Complaint
• Process to File an Appeal
• Request an Expedited Appeal
• Continuing Services During an Appeal
• Request a Hearing (after an unfavorable appeal)

Process to File a Grievance or Make a Complaint

To file a grievance or make a complaint, please call AHCCCS Office of Administrative Legal Services:

Call:

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

Process to File an Appeal

All appeals need to be in writing. Eligibility appeals must be sent to the agency that made the determination (AHCCCS or DES). Appeals related to denials, discontinuances, or reductions in medical services must be sent to the AHCCCS Office of Administrative Legal Services.

To request an appeal, write the AHCCCS Office of Administrative Legal Services:

FAX: 602-253-9115

Request an Expedited Appeal

A request for an expedited appeal can be made if the member or doctor feels that the person's health will be in serious jeopardy (serious harm to life or health or ability to attain, maintain or regain maximum function) by waiting 30 days for a decision. If the appeal is expedited, AHCCCS should resolve the appeal within three working days, absent an  extension.

Continuing Services During an Appeal

Members currently receiving services or benefits may be able to continue to receive them during the appeal process. If services or benefits were reduced, suspended or terminated, a request to continue receiving services during the appeal may be made. The appeal must be filed before the day the reduction, suspension or termination is to take effect. If there is less than 10 days between the notice date and the effective date on the notice, the request for continued services must be filed within 10 days from the notice date. If the appeal is denied, the member may have to pay for the services received during the appeal process.

For further information, contact the Office of Administrative Legal Services.

Request a Hearing (after an unfavorable appeal)

If the AHCCCS decision on the appeal is unfavorable, a hearing referred to as a State Fair Hearing, where the appeal is presented before an administrative law judge, may be requested. A written request for a state fair hearing must be filed with the Office of Administrative Legal Services.