1. A. Provider claim disputes and Member Appeals for a DCS CHP Member who is Medicaid eligible follow the rules prescribed in 9 A.A.C. 34.

2. B. Provider claim disputes and Member Appeals for a DCS CHP Member who is not Medicaid eligible follow:

   1. 1. A.A.C. R9-34-203. Computation of Time,
   2. 2. A.A.C. R9-34-208. Who May File,
   3. 3. A.A.C. R9-34-209. Enrollee Time-frame for Filing an Appeal or Grievance with the Contractor,
   4. 4. A.A.C. R9-34-210. Contractor General Requirements for Grievance or Appeal Process,
   5. 5. A.A.C. R9-34-213. Contractor Time-frame for Standard Resolution of an Appeal,
   6. 6. A.A.C. R9-34-214. Contractor Process for an Expedited Resolution of an Appeal,
   7. 7. A.A.C. R9-34-215. Contractor Time-frame for an Expedited Appeal Resolution,
   8. 8. A.A.C. R9-34-225. Reversed Appeal Resolutions,
   9. 9. A.A.C. R9-34-403. Computation of Time,
   10. 10. A.A.C. R9-34-404. Content of Claim Dispute, and
   11. 11. A.A.C. R9-34-405. Filing a Claim Dispute for a Claim Involving a Member Enrolled with a Contractor.
3. C. Provider claim disputes and Member Appeals hearing procedures for a DCS CHP Member who is not Medicaid eligible follow the rules prescribed in 21 A.A.C. 1, Article 3.

Historical Note

New Section made by final exempt rulemaking at 21 A.A.R. 2554, effective November 30, 2015 (Supp. 15-4).

Amended by final rulemaking at 27 A.A.R. 2518 (October 29, 2021), with an immediate effective date of October 5, 2021 (Supp. 21-4).