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Provider Guidelines for Filing a Claim Dispute

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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

  • DDD's Operations Manual p.207 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 latest.
  • Claim disputes must include factual information and the reason why the claim should be paid. DDD’s Office of Administrative Review will deny a claim dispute if the factual information is not included.
    • The letter must be legible and should be typed in a font size 10 pt. or larger.
    • 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 may be completed in Excel on the Claims Grievance Log. The completed Excel spreadsheet may be submitted on a DVD, CD, or USB drive. Along with the electronic file, a hard copy of this information may be provided.
    • Multiple DDD members can be included on one claim dispute letter, using the template above for each member included in your claim dispute. Claim disputes must be submitted at the individual member ID level.
    • All supporting documentation should be included as attachments to your claim dispute letter.
    • Do not include supporting documentation for members not listed on your claim dispute letter.
  • If you have a billing inquiry please check the GAO website or your Billing Detail Report in FOCUS. A billing inquiry does not constitute filing a claim dispute. A claim dispute can be filed when payment of a claim is disputed or has been denied.
  • DDD’s Claims Adjudication, Medical Coding Manager, Accounting Services Manager, and Office of Administrative Review are not responsible for the reconciliation of your financial accounts.

Adjustment Requests

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

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