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Claim Dispute Information for Contracted and Non-Contracted Providers

Formal Claim Dispute Process

All claim disputes must be hand-delivered or mailed to:

Division of Developmental Disabilities
Office of Administrative Review
1789 West Jefferson Street
Mail Drop 2HE5
Phoenix, Arizona 85007

Guidelines for Filing a Claim Dispute

  • Division Operations Policy Manual Chapter 6000-K Claims Disputes states: “If you disagree with the payment of a claim, denial of a claim, recoupment of a claim, imposition of a claim, or reinsurance you may file a Claim Dispute in accordance with Arizona Revised Statute (ARS) §36-2903.01B and Arizona Administrative Code (AAC) R9-34-404. The Claim Dispute should detail the factual and legal basis of the dispute. A Claim Dispute must be filed in writing and received by DDD no later than 12 months of the date of service, 12 months from the date of eligibility posting, or 60 days after the date of the payment, denial, or recoupment of a timely claim submission, whichever is later."
  • Claim disputes must be filed in writing include the following factual information:
    • Provider AHCCCS ID
    • Provider Name
    • Provider TIN/SSN
    • WellSky Claim ID
    • Member AHCCCS ID
    • Member First Name
    • Member Last Name
    • HCPCS Code/CPT Code
    • DDD Service
    • Start DOS
    • End DOS
    • Total Units
    • Total Amount Billed
    • Supporting information for reason/s the claim should be paid
  • DDD’s Office of Administrative Review will deny a claim dispute if the factual information is not included.
  • Claim disputes must be filed in writing and specify in detail the factual and legal basis for the claim dispute and the relief requested.
  • Documentation MUST be completed in Excel on the Claims Dispute Log.
  • Do not include supporting documentation for members not listed on your claim dispute letter.
  • Qualified Vendors with a billing inquiry should check the GAO website or their Billing Detail Report in FOCUS. Additional questions can be emailed to DDD Provider Relations. They can also be contacted by phone at 1-844-770-9500 option 1, TTY/TDD 711.

Qualified Vendors can learn more about claim denials and how to resolve them by reviewing the WellSky and Focus Claims Denial Resolution Guide.

Non-Medicaid Claim Disputes for State-Funded Services

The Division authorizes some services that are not covered by Medicaid. These services include, but are not limited to room and board. Per RFQVA DDD-2024, Section 10, QVA Claims and Controversies, “Other than protests and claims covered by A.A.C. R6-6-2115 and R6-6-2116, any other claims or controversies under this QVA shall be resolved according to A.A.C. R6-6-2117.” Non-Medicaid claims under Qualified Vendor Agreements shall be filed with the Department Procurement Officer within 12 months of the date the Department has denied payment. The Department Procurement Officer shall have the authority to settle and resolve Qualified Vendor Agreement claims subject to subsection (C).

Non-Medicaid claim disputes submitted following the path designated for Medicaid services in accordance with Arizona Revised Statute (ARS) §36-2903.01B and Arizona Administrative Code (AAC) R9-34-404 will be dismissed. The Qualified Vendor may submit the dispute to the DES Procurement Officer.

Corrected Claims/Resubmissions

Corrected claims/resubmissions must be received by DDD within 12 months from the date of service, 12 months from the date of eligibility posting for a retro-eligibility claim, or 60 days from the date of the adverse action, whichever date is later.

Contracted Providers may upload corrected claims/resubmissions electronically to the Division's WellSky Production site (WellSky account access required).

Non-contracted providers may submit paper claim corrections/resubmissions to:

Division Of Developmental Disabilities
Attn: Claims Department
Mail Drop 2HC6
P.O. Box 6123
Phoenix, AZ, 85005-6123

Questions should be submitted to the DDD Provider Relations Unit via email or by phone at 1-844-770-9500 option 1.

  • Institutional claims shall be subject to quick pay discounts and slow payment penalties in accordance with Arizona Revised Statute (A.R.S. §36-2903.01.G), (A.R.S. §36-2903.01).
  • ALTCS licensed skilled nursing facilities, assisted living facilities, home and community based services, and non-hospital claims shall be subject to interest on payments of the clean claim in accordance with Arizona Revised Statute (A.R.S. §36-2943.D).
  • Adjustment for a previously paid claim. Either through audit or by corrected claim submission from the provider.
  • Balance owed: Remaining balance after current claim payments have been applied. Any remaining balance owed will be applied to future claims.
  • Balance outstanding applied: The previous outstanding balance has been applied to the current payment.
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