AHCCCS Grievance and Appeal System Report

The Grievance and Appeal System Report is designed for use by Acute and Long Term Care Contractors who provide services to AHCCCS members. It contains instructions for completing the following reports:

  • Claims Dispute Report
  • Authorization Request and Appeal Report
  • Member Grievance Reports
  • Member Medicare D-SNP Appeals and Grievance Report

The reports are to be submitted for review to the Division of Health Care Management, as required by the applicable contract.

AHCCCS Grievance and Appeal System Report (Updated 10/01/2016, Updated 08/01/16, Updated 02/24/15, Updated 04/28/14, Updated 02/07/2014, Updated 12/30/2013, Updated 12/12/2013, Originally Posted 10/23/2013)

  • Cover Letter Template (Updated 08/01/16, Updated 02/24/15, Originally Posted 10/23/2013)
  • Attachments A-H(Updated 10/01/2016, Updated 08/01/16, Updated 04/28/14, Updated 02/07/2014, Updated 12/30/2013, Updated 12/12/2013, Originally Posted 10/23/2013)