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PRIMARY CARE PHYSICIAN CHANGE FORM This is a request to change my Primary Care Physician (PCP). The new PCP will be: Dr. (last & first name) (provider s phone number) I confirm this is my request.

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If you need to report a change in your household including, but not limited to, a change of residential or mailing address, your income, household member's change of job, etc., contact the eligibility source where you applied for AHCCCS: DES .healthearizonaplus.gov or 1(855)HEA-PLUS (1-855-432-7587)

Changing Health Plans Members may request a health plan change for the following reasons either through the HEAplus system (healthearizonaplus.gov) or by contacting AHCCCS at (602) 417-7100 or 1-(800)-334-5283: Annual enrollment. Member was auto-assigned and within the first 90 days may request a change in health plan.

Arizona Health Care Cost Containment System (AHCCCS) is Arizona's Medicaid agency that offers health care programs to serve Arizona residents. Individuals must meet certain income and other requirements to obtain services.

Arizona Complete Health's plan is called Ambetter. Ambetter offers affordable health care coverage for individuals and families.

Arizona Complete Health-Complete Care Plan is an integrated health plan for members served by Arizona's Medicaid program, the Arizona Health Care Cost Containment System (AHCCCS). As an integrated plan, our health plan covers both your physical and behavioral health benefits.

Arizona Complete Health has a proud history of serving Arizonans statewide through Medicare Advantage, Marketplace and AHCCCS. At Arizona Complete Health, our purpose is at the center of everything we do: Transforming the Health of the Community, One Person at a Time.

Customer service is available by calling: Provider Customer Service: 1-866-796-0542.

UnitedHealthcare Community Plan is an Arizona Medicaid health plan serving AHCCCS Complete Care, KidsCare, and Developmental Disabilities (DD) members. We have nearly 40 years of experience serving families throughout Arizona.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
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
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
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