Provider Claim Disputes 

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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 Administrative Legal Services (OALS).

AHCCCS
Office of Administrative Legal Services

701 E. Jefferson, MD-6200

Phoenix, AZ 85034

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

Call:

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

Filing a Claim Dispute Involving Enrolled Members

For claim disputes involving enrolled members, the written dispute must be filed with the member's health plan.

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.

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