Date: 08/20/21
Dear AzCH-Complete Care Plan Provider and Billing Team,
Effective 10/01/21, approximately 105,000 Care1st members in Maricopa, Pinal and Gila counties will become AzCH-Complete Care Plan Members. This communication is to assist your team with EDI Claim Submissions, Member Eligibility, Claim Status and Customer Service Inquiries for those members.
We want your claim submissions processed as efficiently and quickly as possible. For the fastest, most accurate processing, electronic claim submission, i.e. EDI, is the preferred method. Please review the date of service guidance below and update your system to submit to the correct payer.
DATE OF SERVICE GUIDANCE
Date of Service (DOS) | Health Plan Name | Claim Type | EDI Clearinghouse Payer ID | Paper Claims Mailing Address |
DOS before 10/01/2021 | Care1st | Professional and Institutional | 14163 | Claims Department PO Box 31224 Tampa, FL 33631 |
DOS on or after 10/01/2021 | AzCH-Complete Care Plan | Professional and Institutional | 68069 | Arizona Complete Health-Complete Care Plan PO Box 9010 Farmington, MO 63640-9010 |
INSTRUCTIONS ON HOW TO DETERMINE CORRECT PAYER FOR DATE OF SERVICE
Professional Services
- When billing a professional service with dates of service (DOS) spanning before and after 10/01/2021, to avoid eligibility rejections, please split the services into two separate claim submissions.
- Also, if the 1st DOS on the claim is prior to 10/01/2021 the claim will reject, so please make sure the 1st DOS listed is 10/01/2021 or after.
- Submit DOS prior to 10/01/21 to Care1st and DOS 10/01/21 and after to AzCH-Complete Care Plan:
- Professional (837P) service date for all claim lines is located in Loop 2400 (DTP*472*from-through~) or in FL-24a the unshaded area on the CMS1500 02/12 paper form.
Institutional Outpatient Bill Type and Non-DRG Services
- When billing dates of service spanning before and after 10/01/2021, to avoid eligibility rejections, please split the services into two separate claim submissions.
- Also, if the 1st DOS on the claim is prior to 10/01/2021, the claim will reject; please make sure the 1st DOS listed is 10/01/2021 or after.
- When billing services with an outpatient bill type or non-DRG institutional services, please use the earliest “From Date” in the claim submission.
- Institutional statement earliest service date is located in Loop 2300 (DTP*434*from-through~) or in FL-06 of the UB-04 CMS-1450 paper form.
Institutional Inpatient DRG Services
- When billing institutional inpatient DRG services please use the ‘Through Date Institutional’ statement date located in Loop 2300 (DTP*434*from-through~) or FL-06 of the UB-04 CMS-1450 paper form.
- Should the admission date and discharge date span the 10/01/2021 cutover date, AHCCCS requires that the “From Date” be sent as the subscriber’s earliest effective date with the payer responsible for the claim based on the date of discharge.
- Also, if the 1st DOS on the claim is prior to 10/01/2021, the claim will reject; please make sure the 1st DOS listed is 10/01/2021 or after.
ELECTRONIC TRANSACTIONS (EDI, EFT/ERA, Provider Portal) DATES OF SERVICE 10/1/21 AND AFTER
For additional detail, please visit the AzCH-Complete Care Plan website: https://www.azcompletehealth.com/ > For Providers > Provider Resources > Claims and Payment > Electronic Transactions.
EDI
For successful EDI claim submission, you will use electronic reporting made available to you by your vendor and clearinghouse. While Availity (ph 800-282-4548) is our preferred EDI partner, other EDI partners are also available and listed on our website on the Electronic Transactions page under EDI.
Secure Provider Web Portal
AzCH-Complete Care Plan offers a secure provider web portal. You may login or register in the Provider Portal section of our Electronic Transactions page on our website. Once your account is created, you can:
- Verify member eligibility
- Submit and check claims
- Submit and confirm authorizations
- View detailed patient list
Electronic Funds Transfer and Electronic Remittance Advice
PaySpan® Health provides Electronic Funds Transfer (EFT) and Electronic Remittance Advice/Explanation of Payment (ERA/EOP) solutions for AzCH-Complete Care Plan. If you are not already registered through AzCH-Complete Care Plan, create a new account by registering at www.payspanhealth.com or by calling 1-877-331-7154.
Note: If you are newly contracted with AzCH-Complete Care Plan (<1 year) you must register with PaySpan to receive EFT and ERA.
PROVIDER CLAIM DISPUTES AND MEMBER APPEALS
Use the date of service logic provided on the first page to determine the correct payer.
Date of Service (DOS) | Mailing Address |
|---|---|
DOS before 10/01/2021 | Care1st Health Plan Attn: Care1st Claims Disputes & Appeals 1870 W Rio Salado Parkway, Tempe, AZ 85281 |
DOS on or after 10/01/2021 | Arizona Complete Health-Complete Care Plan Attn: AzCH-Complete Care Plan Grievances and Appeals 1870 W Rio Salado Parkway, Suite 2A, Tempe, AZ 85281 |
OTHER PROVIDER INQUIRIES
You can reference the AzCH-Complete Care Plan Provider Manuallocated on this site underProvider Resources.If you have other questions, please contact Care1st Provider Services or the AzCH-Complete Care Plan Provider Call Center or reach out to your Provider Engagement Specialist as outlined below.
Date of Service (DOS) | Health Plan | Provider Service Contact Information |
|---|---|---|
DOS before 10/01/2021 | Care1st | 602.778.1800 or 866.560.4042 (Options in order: 5, 7) Fax 602.778.1875 E-mail: sm_az_pno@care1staz.com |
DOS on or after 10/01/2021 | AzCH-Complete Care Plan | 1.866.796.0542 Provider Customer Service If you are unsure of your assigned Provider Engagement Specialist, please e-mail: AzCHProviderEngagement@azcompletehealth.com |
Thank you!
