Waitlist User Registration

You are requesting a user account to access the Arizona Health Care Cost Containment System (AHCCCS) Behavioral Health Waitlist Registration Application.

Step 1: Select your role with reqards to use of the application.

Step 2: Provide all information requested.

Step 3: Submit the request : After validation of the information you have provided you will receeive an email to the email address you have provided with further instructions.

Enter User Information

All fields are required.

First Name: Last Name: Facility: RBHA Name: Phone: Email Address: New Password: Confirm Password: Error: Password and Confirm Password do not match Error: Password Complexity not valid, see below for help. AHCCCS Login Id: Role: Provider RBHA AHCCCS Request Login: Passwords must be at least eight (8) alphanumeric characters long.
At least one (1) Upper case characters (A through Z), At least one (1)
Lower case characters (a through z), At least one (1) Digits (0 through 9)

Request has been accepted

Your request has been accepted. You will receive an email to the email address you provided after your account has been activated.

Error Processing Request

Sorry, but your request can not be processed at this time. Please try again later.

Error Processing Request

Password does not match with our records for this user. :Please try again.

Challenge Questions

Please select three challenge questions from the list below. The selected challenge questions will be used to verify your identity when you request a password reset of your Health Services network login account. After you have selected the three questions, please press the continue button.

Please provide the answers for the challenge questions from the selection you have made. After you have provided the answers and an outside AHCCCS email address, please press the complete button.

Must Select Three, (3) Questions Before You Can Continue

Must Provide an Answer For All Three, (3) Questions

AHCCCS Behavioral Health

AHCCCS Behavioral Health Services Registration