AHCCCS Provider Enrollment Packets

The Provider Enrollment process is required for those who provide medical care services (including primary care doctors, transportation, etc) to AHCCCS beneficiaries.

Provider Enrollment Requirements for Licensed Naturopathic Physician

The Arizona Health Care Cost Containment System (AHCCCS) is accepting applications from licensed Naturopathic Physicians who wish to serve AHCCCS members under Early Periodic Screening Diagnostic and Treatment (EPSDT). This AHCCCS provider type is active and is designated as 17-Naturopath in the AHCCCS Provider Enrollment system.

In order to submit claims for AHCCCS Fee for Service Programs, an active AHCCCS provider enrollment is required. In order to submit claims for AHCCCS managed care organizations (MCOs), Naturopathic physicians will need to be credentialed and contracted with the MCO(s) in addition to having an active AHCCCS provider enrollment.

Provider Enrollment forms are provided in two types of packets:

AHCCCS Provider Address Updates

The Provider Address Update Form is for existing providers to add or change addresses and tax identification numbers on their provider file at AHCCCS.

Click on the appropriate links below:

NOTE: Registered AHCCCS Providers may change their correspondence address using the AHCCCS online Provider Website.

The Out of State/One-time Waiver of Registration Requirements applies to those out of state providers that offer covered services to AHCCCS members. Certain restrictions apply; see One-time Waiver Requirements and Excluded Cities List below.

Providers, who are excluded from this policy, may register using the standard provider enrollment process.

Mail or fax completed and signed enrollment forms.

  • Mail:
    AHCCCS Provider Enrollment
    P.O. Box 25520, Mail Drop 8100
    Phoenix, AZ 85002
  • Fax:
    Attn: AHCCCS Provider Enrollment
    602 256-1474

Note: All applicable licenses and certifications must be submitted with the enrollment forms. If you have questions regarding the types of applicable licenses or certifications, please contact Provider Enrollment at the phone numbers listed below.

For questions regarding the provider enrollment process, please contact the AHCCCS Provider Enrollment Unit.

  • Call:
    • 602-417-7670 Option 5 (calling from Maricopa County)
    • 1-800-794-6862 (calling from in-state, but outside of Maricopa County)
    • 1-800-523-0231 (calling from out of state)
  • Write:
    Arizona Health Care Cost Containment System (AHCCCS)
    ATTN: Provider Enrollment Unit
    PO Box 25520, MD-8100
    Phoenix, AZ 85002