Fee-For-Service Health Plans
AHCCCS was implemented on October 1st of 1982 as the nation’s very first statewide health care program aimed at providing medical care for individuals undergoing financial hardship. The Division of Fee-For-Service Management (DFSM) is a division within the Arizona Health Care Cost Containment System (AHCCCS). DFSM serves as the health plan for Fee-for-Service (FFS) Medicaid members and reimburses claims for other populations of individuals not enrolled with a contractor.
Learn more about AHCCCS Complete Care (ACC): The Future of Integrated Healthcare.
- Member Guides for individuals affected by the closure of a sober living home or residential facility: English/Spanish
How to Access Services
The AHCCCS Division of Fee for Service Management (DFSM) will reimburses AHCCCS enrolled providers across the state of Arizona. If you are looking for services, please refer to the Provider Listing website, which can be sorted by provider name, city, zip code, or specialty.
Your health care is important to us. To become an AHCCCS registered provider, providers must meet strict licensure and service requirements. If you need more information about a provider, you may contact the organizations below:
|NAME OF ORGANIZATION
|Arizona Medical Association
|Arizona Medical Board
|American Board of Medical Specialties
|Arizona State Board of Dental Examiners
|Arizona Board of Osteopathic Examiners
|Arizona State Board of Optometry
|Arizona Department of Health Services – Care Check
|Arizona State Board of Behavioral Health Examiners
As a reminder, it is illegal for providers to give incentives to members, including but not limited to gift cards, meals, cash to encourage members to select a provider for needed services. Any provider offering incentives could face penalties and lose their licensure.
Grievances and Appeals
Members enrolled in the American Indian Health Program (AIHP), have the right to file a grievance, make a complaint, or file an appeal.
An appeal is a request from an applicant, member, provider, health plan, or other approved entity to reconsider or change a decision, also known as an action. An action includes any denial, reduction, suspension, or termination of a service or benefit, or a failure to act in a timely manner. An appeal is the formal procedure asking us to review the request again and confirm if our original decision was correct.
Examples of actions:
- Denial of request for surgery
- Denial of a request for a wheelchair
- Denial of basic health care services
- Denial or discontinuance of AHCCCS eligibility
Process to File an Appeal
All appeals need to be in writing. Appeals related to denials, discontinuances, or reductions in medical services must be sent to the AHCCCS Office of the General Counsel.
To request an appeal, write the AHCCCS Office of the General Counsel:
Office of The General Counsel
Arizona Health Care Cost Containment System Administration (AHCCCS)
801 E. Jefferson St., MD-6200
Phoenix, AZ 85034
During the appeal process, you may submit additional supporting documents or information that you believe would support a different outcome and decision.
After we review your appeal, we will send you our decision in writing within 30 days of the date we received your appeal request.
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.
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 the General Counsel.
Report Concerns About the Quality of Care Received for Medicaid Services
AHCCCS is dedicated to providing quality health care to all members and to ensuring that health care services are available. If you or any AHCCCS member has experienced difficulties in obtaining health care services or have concerns about the quality of services received, please report it to Clinical Quality Management (CQM) using this online form, by calling (602) 417-4885, or by emailing CQM@azahcccs.gov. All submissions are confidential and protected by Arizona state statute.
To verify a provider’s license, and view cited deficiencies and corrective action enforcement, see www.AZCareCheck.com .