Section R9-34-407. Filing a Claim Dispute for a Claim Involving an FFS Member

A.       For a claim for an FFS member, the provider shall file a writ­ ten claim dispute with AHCCCS under the timelines in A.R.S.

§ 36-2903.0l(B)(4).

B.       AHCCCS shall mail a written Notice of Decision of the claim dispute to the provider no later than 30 days after the provider files the claim dispute with AHCCCS, unless AHCCCS and the provider agree to a longer period.

C.     AHCCCS' written Notice of Decision shall include:

1.       The date of the decision,

2.        The factual and legal basis for the decision,

3.        The provider's right to request a State Fair Hearing under A.RS. § 41-1092, et seq., and

4.        The manner in which a provider is to file a State Fair Hearing request under A.RS. § 41-1092 et seq.

D.       A provider may request a State Fair Hearing on AHCCCS' Notice of Decision if:

1.       The provider files a written request for a State Fair Hear­ ing with AHCCCS no later than 30 days after the date the provider receives the AHCCCS' written Notice of Deci­ sion, or

2.        AHCCCS does not render a written Notice of Decision within 30 days after the claim dispute is filed and the pro­ vider files a written request for a State Fair Hearing based on AHCCCS' failure or refusal to decide the claim dis­ pute within 30 days after the date that the Notice of Deci­ sion should have been mailed.

E.    AHCCCS shall mail a Notice of Hearing under A.R.S. § 41-

1092.05 if AHCCCS receives a timely request for a State Fair Hearing from the provider.

F.       AHCCCS shall mail a Director's Decision to the provider no later than 30 days after the date the Administrative Law Judge sends the OAH decision to AHCCCS.

G.      AHCCCS shall accept a written request for withdrawal if the written request for withdrawal is received from the provider before AHCCCS mails a Notice of Hearing under A.RS. § 41- 1092 et seq. If AHCCCS mailed a Notice of Hearing under A.RS. § 41-1092 et seq., a provider shall send a written request for withdrawal to OAH.

Historical Note

New Section made by final rulemaking at 10 A.A.R. 828, effective April 3, 2004 (Supp. 04-1).

R9-34-408.         Denial of a Request for a State Fair Hearing AHCCCS shall deny a request for hearing under A.RS. § 41-1092, et seq., upon written determination that:

1.       The request for hearing is untimely;

2.        The request  for hearing is not for an action permitted under this Article;

3.        The provider or contractor waives the right to a hearing; or

4.        The request for hearing is moot, as determined by AHC­ CCS, based on the factual circumstances of the case.

Historical Note

New Section made by final rulemaking at 10 A.AR. 828, effective April 3, 2004 (Supp. 04-1).