Submit a Provider Interest Form and attach the required AzAHP forms.
Attach the appropriate AzAHP form(s) to the Provider Interest Form only after AHCCCS Registration is completed. Include the documents requested on page 1 of the AzAHP form with your Provider Interest Form. Without the necessary documents, a contracting decision cannot be made.
Behavioral Health providers should include a summary description of programs, including target populations and age categories, specific models of care/therapies used, along with frequency of programming treatment and complete Exhibit E for each location. See link to instructions and form below.
If you have contract-related inquiries, questions or need to provide additional supporting documentation, please email [email protected]. Please allow 120 days before requesting status on a new contract. Please include the name of your organization and tax identification number in your email.