Ariz. Admin. Code § R9-34-405 - Filing a Claim Dispute for a Claim Involving a Member Enrolled with a Contractor
A. For
a claim for services rendered to a member enrolled with a contractor, the
provider shall file a written claim dispute with the contractor under the
timelines in A.R.S. §
36-2903.01(B)(4).
B. The contractor shall mail a written Notice
of Decision of the claim dispute to the provider no later than 30 days after
the provider files the claim dispute with the contractor, unless the provider
and contractor agree to a longer period.
C. The contractor's written Notice of
Decision shall include:
1. The date of the
decision,
2. The factual and legal
basis for the decision,
3. The
provider's right to request a State Fair Hearing under A.R.S. §
41-1092,
et seq., and
4. The manner in which
a request for a State Fair Hearing is filed under A.R.S. §
41-1092,
et seq.
D. A provider
may request a State Fair Hearing on the contractor's Notice of Decision if:
1. The provider files a written request for a
State Fair Hearing with the contractor no later than 30 days after the date the
provider receives the contractor's written Notice of Decision, or
2. The contractor does not render a written
Notice of Decision within 30 days after the claim dispute is filed and the
provider files a written request for a State Fair Hearing within 30 days after
the date that the Notice of Decision should have been mailed.
E. AHCCCS shall mail a Notice of
Hearing under A.R.S. §
41-1092.05
to the parties if a contractor receives a timely request for hearing from the
provider.
F. AHCCCS shall mail a
Director's Decision to the provider no later than 30 days after the date the
Administrative Law Judge sends the OAH decision to AHCCCS.
G. AHCCCS shall accept a written request for
withdrawal if the written request for withdrawal is received from the provider
before AHCCCS mails a Notice of Hearing under A.R.S. §
41-1092,
et seq. If AHCCCS mailed a Notice of Hearing under A.R.S. §
41-1092,
et seq., a provider shall send a written request for withdrawal to OAH.
Notes
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