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Provider Guidelines for Filing a Claim Dispute
- All claim disputes must be hand delivered or ground mailed to:
Division of Developmental Disabilities
Office of Administrative Review
3443 North Central Avenue, 9th Floor-Suite #916
DES Mail Drop: 2HE5
Phoenix, Arizona 85012
Claim Disputes will not be accepted via e-mail or text.
- Division of Developmental Disabilities Operations Manual p.2200 states “...The claim dispute must be filed within 12 months after the date(s) of service, within 12 months after the member’s eligibility is posted or within 60 days after the date of the denial of a timely claim submission,” whichever is later.
- Claim disputes must include factual information and the reason why the claim should be paid. Office of Compliance and Review will deny a claim dispute if the factual information is not included in the claim dispute.
- The letter must be legible and therefore will need to be written in a font size10 pt or larger.
- Providers should follow the template cover letter for all claim disputes.
- Documentation must be completed in Excel on the provided spreadsheet (286 KB XLS). The completed Excel spreadsheet must be submitted on a floppy disk or CD. Along with the electronic file, a hard copy of this information may be provided.
- Multiple consumers can be included on one claim dispute letter, using the template above for each consumer included in your claim dispute. Claim disputes must be submitted at the individual client ID level.
- All supporting documentation should be included as attachments to your claim dispute letter.
- Do not include supporting documentation for consumers not listed on your claim dispute letter.
- If you have a billing inquiry please check the GAO website or your Billing Detail Report in QVP. A billing inquiry does not constitute filing a claim dispute. A claim dispute can be filed when payment of a claim is disputed or a claim has been denied.
- Division of Developmental Disabilities Claims Adjudication and Accounting Services Manager and Division of Developmental Disabilities Office of Compliance and Review is not responsible for the reconciliation of your financial accounts.