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.

Provider Registration forms are provided in two types of packets:

  • Individuals/Companies/Facilities Packet

    Individuals, companies and facilities, must complete all of the following forms. Exceptions are noted.

  • Group Biller Packet

    The Group Billing Packet contains the forms that are required for an organization acting as the financial representative of any provider or group of providers who have authorized the organization to act in their behalf. Entities applying for a group biller number must complete all the following forms in the registration packet.

  • If registering as one of the following provider types listed below, complete the applicable profile, review any special registration requirements notated by the provider type, and submit with your application.

    Note: Existing providers may use the Provider Registration Application to update their address on their provider registration file.

AHCCCS Provider Address Updates

The Provider Address Update Form is for existing providers to add or change addresses and tax identification numbers on their provider file at AHCCCS.

Click on the appropriate links below:

NOTE: Registered AHCCCS Providers may change their correspondence address using the AHCCCS online Provider Website.

The Out of State/One-time Waiver of Registration Requirements applies to those out of state providers that offer covered services to AHCCCS members. Certain restrictions apply; see One-time Waiver Requirements and Excluded Cities List below.

Providers, who are excluded from this policy, may register using the standard provider registration process.

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.

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