AHCCCS Provider Resubmission and Reconsideration Process

In order to streamline requests for FFS resubmissions and reconsiderations, the Division of Fee for Service Management has developed a new process for providers to submit these claims and prior authorization re-reviews.

For Claims:

A "Resubmission" is defined as a claim originally denied because of missing documentation, incorrect coding, etc., which is now being resubmitted with the required information.

A "Reconsideration" is defined as a request for review of a claim that a provider feels was incorrectly paid or denied because of processing errors.

When filing resubmissions or reconsiderations, please include the following information:

  • An updated copy of the claim
  • A copy of the original claim (reprint or copy is acceptable)
  • A copy of the remittance advice on which the claim was denied or incorrectly paid
  • Any additional documentation required
  • A brief note describing what correction is needed. If the provider is unwilling to justify in writing why a legitimately denied claim deserves reconsideration, it will be difficult for AHCCCS to reverse its decision.

Each claim should be identified clearly with the words "resubmission" or "reconsideration".

Mail all resubmission and reconsideration requests to:

AHCCCS Claims Department
Attn: Resubmission & Reconsideration
701 E. Jefferson MD 8200
Phoenix, AZ 85034

You have 12 months from the date of service to request a resubmission or reconsideration of the claim.

A request for review or reconsideration of a claim does not constitute an appeal or Provider Claim Dispute (see Chapter 28 [PDF] in the FFS Provider Manual and Chapter 19 [PDF] in the IHS/Tribal Provider Manual).

For Prior Authorization:

A "Reconsideration" is defined as a request for review of a prior authorization that a provider feels was incorrectly denied or prior authorized. This could include a change in tier status, missing documentation, incorrect CPT/HCPCS codes or units or date of service change.

When filing reconsiderations, please include the following information:

  • Any additional documentation required
  • A brief note describing what correction is needed. If the provider is unwilling to justify in writing why a legitimately denied claim deserves reconsideration, it will be difficult for AHCCCS to reverse its decision.

Each Prior Authorization should be identified clearly with the word "reconsideration".

Mail all reconsideration requests to:

AHCCCS Prior Authorization
Attn: Reconsideration
701 E. Jefferson MD 8900
Phoenix, AZ 85034

Providers have 12 months from the date of service to request a reconsideration of the claim, so prior authorizations must be updated prior to the submission of a claim resubmission.

A request for review or reconsideration of a claim does not constitute an appeal or Provider Claim Dispute (see Chapter 28 [PDF] in the FFS Provider Manual and Chapter 19 [PDF] in the IHS/Tribal Provider Manual).


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