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Member Change Request Online


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Member Change Request Online is a Internet application that allows program contractors to submit electronic change request forms to Arizona Health Care Cost Containment System (AHCCCS).

To start using Member Change Request Online you must create an account and login. Creating an account is easy. Simply click the “Create Account” link above and follow the directions.

If you have forgotten your password, click the “I forgot my password” link. Your password will be emailed to the address used when the account was created.

If you are experiencing technical problems with this site please contact the AHCCCS Help Desk at 602-417-4451.