Section R9-22-1008. Notification Information for Liens

A.      Except as provided in subsection (B), a hospital, provider, and noncontracting provider identified in R9-22-1007 shall pro- vide the following information to AHCCCS in writing:

1.        Name of the hospital, provider or noncontracting pro- vider;

2.        Address of the hospital, provider or noncontracting pro- vider;

3.        Name of member;

4.        Member’s Social Security Number or AHCCCS identifi- cation number;

5.        Address of member;

6.        Date of member’s admission or date service is provided;

7.        Amount estimated to be due for care of member;

8.        Date of discharge, if member has been discharged;

9.        Name of county in which injuries were sustained; and

10.     Name and address of all persons, firms, and corporations and their insurance carriers identified by the member or legal representative as being liable for damages.

B.       If the date of discharge is not known at the time the informa- tion in subsection (A) is provided, a party identified in subsec- tion (A) shall notify AHCCCS of the date of discharge within 30 days after the member has been discharged.

Historical Note

New Section made by final rulemaking at 10 A.A.R. 1146, effective May 1, 2004 (Supp. 04-1). Amended by

final rulemaking at 15 A.A.R. 179, effective March 7,

2009 (Supp. 09-1).