R9-22-1008. Notification Information for Liens

A. Except as provided in subsection (B), a hospital, provider, and noncontracting provider identified in R9-22-1007 shall provide the following information to AHCCCS in writing: 1. Name of the hospital, provider or noncontracting provider; 2. Address of the hospital, provider or noncontracting provider; 3. Name of member; 4. Member’s Social Security Number or AHCCCS identification number; 5. Address of member; 6. Date of member’s admission or date service is provided; 7. Amount estimated to be due for care of member; 8. Date of discharge, if member has been discharged; 9. Name of county in which injuries were sustained; and 10. Name and address of all persons, firms, and corporations and their insurance carriers identified by the member or legal representative as being liable for damages. B. If the date of discharge is not known at the time the information in subsection (A) is provided, a party identified in subsection (A) shall notify AHCCCS of the date of discharge within 30 days after the member has been discharged.