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  • Fair Hearing Request Form For Ahcccs/altcs Service Denials

Get Fair Hearing Request Form For Ahcccs/altcs Service Denials

Member Request for an AHCCCS/ALTCS Appeal Fair Hearing AHCCCS/ALTCS Member Information: Member Name: Address: City, State, Zip: AHCCCS ID #: Date of Birth: Phone: Information about Person Filing Appeal.

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To qualify for AHCCCS, most people must meet several basic requirements: Be under 65 years old. You can be 65 or older if you are the parent or caretaker of a child. Not be eligible for Medicare. ... Be a U.S. citizen or meet specific noncitizen requirements, and. Have income below certain limits.

Replace a lost member card Members who are NOT enrolled with a health plan should call AHCCCS at 602-417-7000 or 800-962-6690 to obtain a new member card.

AHCCCS is Arizona's State Medicaid Program. AHCCCS Members who also have Medicare are called Dual Eligible Members. Being enrolled in the same health plan for Medicare and Medicaid is called “alignment.” Alignment provides: • One plan that coordinates all care.

Health Net Access and Cenpatico Integrated Care are now Arizona Complete Health! At Arizona Complete Health we understand that nothing is more important than taking care of you and your family. Our Medicaid, Marketplace, and Medicare insurance plans are here to help you support your healthcare needs.

Founded in 1982, the Arizona Health Care Cost Containment System (written as AHCCCS and pronounced 'access') is Arizona's Medicaid program, a federal health care program jointly funded by the federal and state governments for individuals and families who qualify based on income level.

Arizona Health Care Cost Containment System (AHCCCS) is Arizona's Medicaid agency that offers health care programs to serve Arizona residents.

Process to File an Appeal All appeals need to be in writing. Eligibility appeals must be sent to the agency that made the determination (AHCCCS or DES). Appeals related to denials, discontinuances, or reductions in medical services must be sent to the AHCCCS Office of the General Counsel.

AHCCCS Administration. AHCCCS Central Office. From 602, 623, 480 area codes: 602-417-4000. From 928 or 520 area codes: 1-800-654-8713. From any other area code: 1-800-523-0231. AHCCCS Rulemaking. Call: 602-417-4232. Media Relations and Public Records. Call: 602-417-4729. Email: PIO@azahcccs.gov.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232