AzAHP Delegated Roster
Date: 02/27/24
NEW AzAHP Credentialing Alliance Delegated Roster Template
The Arizona Association of Health Plans (AzAHP) Credentialing Alliance is implementing a standardized delegated roster template for all approved delegated credentialing entities. If you are approved for delegated credentialing, we ask that you please begin using the AzAHP Delegated Roster as soon as possible, and no later than April 1, 2024.
The AzAHP Delegated Roster Template contains additional data elements included on the AzAHP Practitioner Data Form and AzAHP Organizational/Facility Application needed to document AHCCCS requirements along with data elements specific to the delegated credentialing agreement, i.e., initial credentialing date, recredentialing date.
The AzAHP Delegated Roster Template can be reached via the AzAHP Delegated Group Roster link on our websites:
- AzCH-CCP Credentialing Forms
- Care1st Credentialing Forms
- Once the link directs you to AzAHP’s Credentialing Alliance site scroll down to the Credentialing Forms section and click to download the roster template
AzCH providers and staff:
If you have questions, please contact your AzCH Provider Engagement Specialist. If you need your assigned Provider Engagement Specialist’s contact information, please email us at AzCHProviderEngagement@azcompletehealth.com.
Care1st providers and staff:
If you have questions, please call Network Management at 1-866-560-4042 (Options in order: 5, 7) or email SM_AZ_PNO@care1staz.com.
Thank you!