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 Office of General Counsel (OGC).AHCCCS
Office of the General Counsel
701 E. Jefferson, MD-6200
Phoenix, AZ 85034
For questions concerning a Fee-For-Service claim dispute:
- 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.