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).

FFS claim disputes may be filed through the AHCCCS Solution Center in lieu of submitting a written dispute request. For more information on using the AHCCCS Solutions Center, please see the Provider User Guide.

Upon submitting the claims dispute, a claims dispute tracking number will be automatically issued to the submitter via their email address. Providers can include other team members as “collaborators or observers” to also have access to view the dispute. The tracking number for the dispute should be utilized for all follow-up inquiries and must be addressed to the OGC Appeals Specialist who is assigned to the case. This information can be found on the dispute.

AHCCCS
Office of the General Counsel
150 N. 18th Ave., MD 15013
Phoenix, AZ 85007

For questions concerning a Fee-For-Service claim dispute:

Call:

  • 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.