AHCCCS Provider Resubmission and Reconsideration Process

In order to streamline requests for FFS resubmissions and reconsiderations, the Division of Fee for Service Management has developed a new process for providers to submit these claims and prior authorization re-reviews.

For Claims:

Resubmissions

A "Resubmission" is defined as a claim originally denied because of missing documentation, incorrect coding, etc., which is now being resubmitted with the required information.

When filing resubmissions or reconsiderations, please include the following information:

A corrected claim;
Cover letter with "RESUBMISSION" written or typed (do not write on the claims);
A copy of the remittance advice on which the claim was denied or incorrectly paid; and
Any additional documentation required.

Each claim should be identified clearly with the words "resubmission" or "reconsideration".

Mail all resubmission and reconsideration requests to:

AHCCCS Claims Department
Attn: Resubmission & Reconsideration
801 E. Jefferson MD 8200
Phoenix, AZ 85034

Reconsiderations

A "Reconsideration" is defined as a request for review of a claim that a provider feels was incorrectly paid or denied because of processing errors.

When filing reconsiderations, please include the following information:

A copy of the original claim (reprint or copy is acceptable)
Cover letter with "RECONSIDERATION" written or typed;
A copy of the remittance advice on which the claim was denied or incorrectly paid
Any additional documentation required
A brief note describing what correction is needed. If the provider is unwilling to justify in writing why a legitimately denied claim deserves reconsideration, it will be difficult for AHCCCS to reverse its decision.

Mail all reconsiderations requests to:

AHCCCS Prior Authorization
Attn: Reconsideration
801 E. Jefferson MD 8900
Phoenix, AZ 85034

Providers have 12 months from the date of service to request a reconsideration of the claim, so prior authorizations must be updated prior to the submission of a claim resubmission.

A request for review or reconsideration of a claim does not constitute an appeal or Provider Claim Dispute (see Chapter 28 | Rich Text Version in the FFS Provider Manual and Chapter 19 | Rich Text Version in the IHS/Tribal Provider Manual).

For Prior Authorization:

A "Reconsideration" is defined as a request for review of a prior authorization that a provider feels was incorrectly denied or prior authorized. This could include a change in tier status, missing documentation, incorrect CPT/HCPCS codes or units or date of service change.