The electronic payment option processes payments using the Automated Clearing House (ACH). This method enables providers to receive reimbursement more quickly than issuing a check. The Arizona Clearing House Association (ACHA) processes the payment directly to the provider's bank account through Bank of America, which functions as the State servicing bank.
The ACH Vendor Authorization form is used by providers to begin receiving electronic Fee-For-Service reimbursement. You may complete and submit the form yourself by going to:
This is where providers go to check claims' status or to submit claims electronically. Once logged in, click on EFT ENROLLMENT on the top-left of the screen.
Note: This form may be filled out online and faxed to AHCCCS Finance Section, Fax Number 602-258-5943, or email the application to AHCCCS_EFT_Enrollment@azahcccs.gov.
Submit the completed form to the following address for processing:
Arizona Health Care Cost Containment System (AHCCCS)
