Provider Guidelines for Filing a Claim Dispute

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 the Division of Developmental Disabilities (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 Arizona Health Care Cost Containment System (AHCCCS) ID
  • Provider Name
  • Provider Taxpayer Identification Number (TIN)/Social Security Number (SSN)
  • WellSky Claim ID
  • Member AHCCCS ID
  • Member First Name
  • Member Last Name
  • Healthcare Common Procedure Coding System (HCPCS) Code/Current Procedural Terminology (CPT) Code
  • DDD Service
  • Start Date of Service(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 General Accounting Office (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.

Adjustment Requests

Providers should submit a corrected or voided claim through the WellSky system.

The following videos are available for Qualified Vendors to use as a reference when submitting corrected or voided claims.

• WellSky Training Resubmit Void or Void and Replace A Claim Using 837 File
• WellSky Training Void or Void and Replace a Claim
• WellSky Training Correcting Claims
• WellSky Training Remittance Reconciliation Post Remittance Activities

Qualified Vendors should visit the WellSky Claims Processing System page for additional information and resources.