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Arizona Health Care Cost Containment System (AHCCCS) fax number

(888) 507-3313

Centralized Support Unit (AHCCCS ALTCS)

Used for: ALTCS (Arizona Long Term Care Services) application submission using DE-101 (Request for Application for ALTCS).

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Fax destination details

Department: Centralized Support Unit (AHCCCS ALTCS)
Purpose: ALTCS (Arizona Long Term Care Services) application submission using DE-101 (Request for Application for ALTCS).
Form: DE-101 (07/2019) — Request for Application for Arizona Long Term Care Services (ALTCS)
Address: Centralized Support Unit, 801 East Jefferson MD 3900, Phoenix, AZ 85034
Voice phone: 602-417-6600
Website: Visit organization website

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Confirm that this exact department handles your document or request.
Check the organization website or call its main line for the current fax number.
Include a cover sheet and any case, member, claim, or form reference required.
Keep the delivery confirmation with your submission records.

Fill the DE-101 form with applicant and authorized representative information and return via mail, fax to 1-888-507-3313, or take to a local ALTCS office as listed.

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