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Janice K. Brewer Governor STATE OF ARIZONA ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM Thomas J* Betlach Director PROMOTING HONESTY AND INTEGRITY OFFICE OF INSPECTOR GENERAL Provider Address Update Form Completed W-9 Must Be Included NAME Last First M. I. SOCIAL SECURITY NUMBER GENDER FEMALE AHCCCS PROVIDER ID MALE DATE OF BIRTH NPI CHECK ONE ADD ADDITIONAL INFORMATION REPLACE EXISTING INFORMATION NOTE Form will be returned if not completed* CORRESPONDENCE ADDRESS STREET LINE 1 CITY BUSINE ...

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How do I report changes to health-E-Arizona?

You may report a change by calling the Customer Support Center at 1-855-432-7587. 2. By faxing your information to the Centralized Fax Server: When faxing from area codes 480, 602, 623, fax to 602-257-7031 or when faxing from any other area codes, use Toll Free number 1-844-680-9840.

How can I check if my AHCCCS is active?

Information on that process can be obtained by calling the AHCCCS Help Desk at (602) 417-4451. AHCCCS has developed a Web application that allows providers to verify eligibility and enrollment using the Internet.

How do I change my AHCCCS health plan?

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.

How do I find my AHCCCS case number?

You will get an AHCCCS ID card from your health plan. Keep your AHCCCS ID card with you. If you do not have your AHCCCS ID card with you, you can give the provider your AHCCCS ID number or Social Security number so they can look up your AHCCCS information.

How do I upload documents to health-E-Arizona?

There are several ways for you to give us the needed documents: Online: www.healthearizonaplus.gov Select the following links for HEAplus Tip Sheets for directions: Uploading Documents to Health-e-Arizona Plus. ... Mail: PO Box 19009, Phoenix, AZ 85005-9009. In person: To find an office near you:

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Are AHCCCS and Medicaid the same?

The Arizona Health Care Cost Containment System (AHCCCS) is Arizona's Medicaid agency, and Medicaid within the state is often referred to as \u201cAHCCCS.\u201d Although the agency provides the medical insurance coverage, DES determines the eligibility for Medicaid.

How much money can you make and still get AHCCCS in Arizona?

You and your family can usually get AHCCCS if your family's income is at or below 138% of the Federal Poverty Guidelines (FPG) ($18,754 for an individual in 2022, $38,295 for a family of four).

How do I change my AHCCCS?

There are two ways for AHCCCS members to change their AHCCCS enrollment: Online: www.healthearizonaplus.gov. Phone: In Maricopa County: 602-417-7100. Outside Maricopa County: 1-800-962-6690.

How do I report income changes to AHCCCS?

By calling 1-855-432-7587 or 1-855-HEAplus. By completing the Change Report form and mailing, faxing, or submitting it to your local DES office.

How do I change my address with AHCCCS?

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 www.healthearizonaplus.gov or 1(855)HEA-PLUS (1-855-432-7587)

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How do I report changes to health-E-Arizona?

How can I check if my AHCCCS is active?

How do I change my AHCCCS health plan?

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Are AHCCCS and Medicaid the same?

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