Ariz. Admin. Code § R21-1-213 - Provider Claim Disputes and Appeals

A. Claim disputes are governed by the Medicaid rules in 9 A.A.C. Chapter 34.

B. Appeals by Title XIX and Title XXI eligible CMDP Members are governed by the Medicaid rules for State Hearings in 9 A.A.C. Chapter 34.

C. Appeals by State-Only Members are governed by Article 3 of this Chapter.

A. Provider claim disputes and Member Appeals for a DCS CHP Member who is Medicaid eligible follow the rules prescribed in 9 A.A.C. 34.

B. Provider claim disputes and Member Appeals for a DCS CHP Member who is not Medicaid eligible follow:

1. A.A.C. R9-34-203 . Computation of Time,

2. A.A.C. R9-34-208 . Who May File,

3. A.A.C. R9-34-209 . Enrollee Time-frame for Filing an Appeal or Grievance with the Contractor,

4. A.A.C. R9-34-210 . Contractor General Requirements for Grievance or Appeal Process,

5. A.A.C. R9-34-213 . Contractor Time-frame for Standard Resolution of an Appeal,

6. A.A.C. R9-34-214 . Contractor Process for an Expedited Resolution of an Appeal,

7. A.A.C. R9-34-215 . Contractor Time-frame for an Expedited Appeal Resolution,

8. A.A.C. R9-34-225 . Reversed Appeal Resolutions,

9. A.A.C. R9-34-403 . Computation of Time,

10. A.A.C. R9-34-404 . Content of Claim Dispute, and

11. A.A.C. R9-34-405 . Filing a Claim Dispute for a Claim Involving a Member Enrolled with a Contractor.

C. Provider claim disputes and Member Appeals hearing procedures for a DCS CHP Member who is not Medicaid eligible follow the rules prescribed in 21 A.A.C. Chapter 1, Article 3.

Notes

Ariz. Admin. Code § R21-1-213

Adopted by exempt rulemaking at 21 A.A.R. 2554, effective 11/30/2015. Amended by final rulemaking at 27 A.A.R. 2518, effective 10/5/2021.