Required Use of the Delegated Group AzAHP Roster

Date: 05/02/25

The participants of the Arizona Association of Health Plans (AzAHP) Credentialing Alliance, include the six contracted AHCCCS Health Plans that provide healthcare services to over two million Arizonans enrolled in the Arizona Health Care Cost Containment System (AHCCCS).  Healthcare providers who serve AHCCCS members must be contracted to participate in an AHCCCS Health Plan Network. To ensure consistent and efficient credentialing processes, these AHCCCS Health Plans utilize a universal credentialing process to gather required information for directories with demographic and member access details. Standardized templates have been developed to meet these requirements as identified by AHCCCS.

These standardized forms and rosters have been distributed and used since 2012.  Each year, the AzAHP Credentialing Alliance reviews and makes necessary updates to these templates to ensure all AHCCCS requirements continue to be met.  The current form, Delegated Group AzAHP Roster, was completed in February 2024, aligning with other credentialing forms and roster applications. This roster includes additional data elements that may not have been requested previously. Use of the template will ensure all information is obtained and in a standardized format and that the same data elements are obtained from all practitioners/providers whether practicing as an individual, in a group or within a delegated agreement with the health plan.

Effective October 1, 2025, this Delegated Group AzAHP Roster form will be mandatory for  contracted delegated credentialed entities to submit to all the AHCCCS Health Plans. This requirement aims to facilitate administrative ease and consistency as you work with your contracted AHCCCS Health Plans.  Non-compliance with using the standardized roster will result in a delay processing your data by all health plans.  Please contact your health plan representative(s) if you have any questions.