AHCCCS Provider Registration Packets

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

Registration Packets

Note: Information provided in PDF files.

Provider Registration forms are provided in two types of packets:

Reenrollment Packet

Note: Information provided in PDF files.

Where to Send Completed Forms

Mail or fax completed and signed registration forms.

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

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

Who to Contact with Questions

For questions regarding the provider registration process, please contact the AHCCCS Provider Registration Unit.

  • Call:
    • In Maricopa County: 602-417-7670 and select option 5
    • Outside Maricopa County: 1-800-794-6862
    • Out-of-State: 1-800-523-0231
  • Write:
    Arizona Health Care Cost Containment System (AHCCCS)
    ATTN: Provider Registration Unit
    PO Box 25520, MD-8100
    Phoenix, AZ 85002