Ariz. Admin. Code § 21-1-213

Current through Register Vol. 31, No. 2, January 10, 2025

Section R21-1-213 - Provider Claim Disputes and Appeals

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.

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.