Claims
Electronic Data Interchange (EDI)
At AZ Blue Health Choice, we accept both electronic and paper claims from providers. To help you improve your efficiency so that you can focus on patient care, we encourage you to submit claims electronically by utilizing Electronic Data Interchange (EDI).
The benefits of EDI are:
- Faster transaction time and payment.
- Reduced operational costs compared to paper claims (printing, collating, postage, etc.).
- Increased accuracy resulting from validation of data elements.
- Reduced adjustments.
In Arizona, we work with Change Healthcare to make the electronic claims submission process as seamless as possible. AZ Blue Health Choice is fully 5010-compliant, and can also accept 4010 claims. You can enroll with Change Healthcare at www.changehealthcare.com/enrollment
Change Healthcare Change Healthcare | HCFA 1500 – Professional (837P) UB 92 and UB 04 – Institutional (837I) Eligibility Inquiry and Response (270/271) Claims Status Inquiry/Response (276/277) Electronic Remittance Advice (835) | RP105 RP105 |
The ADA Dental Claim Form provides a common format for reporting dental services to a patient’s dental benefit plan. The claim form enables reporting of a National Provider Identifier (NPI), in addition to a current proprietary provider identifier, for both the Billing Dentist/Dental Entity and for the Treating Dentist.
It’s every provider’s responsibility to make sure that an NPI is obtained if the provider is required to do so. If you’re not sure, it’s time to investigate.
Health care providers can apply for National Provider Identifiers (NPI) in one of three ways:
- For the most efficient application processing and the fastest receipts of NPIs, health care providers should consider using the web-based NPI application process. They can log onto The National Plan and Provider Enumeration System (NPPES) and apply online.
- Health care providers can agree to have an Electronic File Interchange (EFI) organizational submit application data on their behalf (i.e. through a bulk enumeration process)
- Health care providers may wish to obtain a copy of the paper NPI Application/Update Form (CMS-10144) and mail the completed, signed application to the NPI Enumerator located in Fargo, ND, whereby staff and the NPI Enumerator will enter the application data into NPPES.
The form will be available only upon request through the NPI Enumerator. Health care providers who wish to obtain a copy of this form must contact the NPI Enumerator in any of these ways:
Phone: 1-800-465-3203 TTY/TTD users call 711
E-mail: customerservice@npienumerator.com
Mail: NPI Enumerator P.O. Box 6059 Fargo, ND 58108-6059
Timely Filing:
Non-Contracted Providers
Initial Claim: 12 months from the date of service.
Corrected Claim: 12 months from the date of service.
Contracted Providers:
Initial Claim: 6 months from the date of service.
Corrected Claim: 12 months from the date of service.
Claim Submissions (Initial Claim) Claim Re-submission (Corrected Claim) Dispute Second Level Dispute | 12 Months from the Date of Service 12 Months from the processing date of the original claim submission 30 Business days to ask for open negotiation After open negotiation, 4 business days to seek Federal IDR | 6 Months from Date of Service 12 Months from Date of Service Disputes related to coverage, benefit book exclusions, medical necessity, non-contracted claim denials Within 2 years from date of denial (there is only one level of internal appeal)Payment disputes (Services are covered, provider believes the services weren’t reimbursed correctly/underpaid) One year after denial or other notification, or date of the occurrence if the provider did not receive notification (level one, internal appeal) Disputes related to coverage, benefit book exclusions, medical necessity, non-contracted claim denials Up to 4 months from date of final internal adverse determination (external)Payment disputes (Services are covered, provider believes the services weren’t reimbursed correctly/underpaid) Within 60 days of Provider’s receipt of Level 1 decision (level two, internal appeal) |
Additional Information
For questions regarding claims, call BCBSAZ Health Choice:
Toll-free: 800-322-8670
Maricopa County: 480-968-6866
Electronic Funds Transfer Request
To participate in electronic data interchange, please complete contact your Network Provider Performance Representative.
Mailing Address for Paper Claims:
ACA StandardHealth with Health Choice
P.O. BOX 52033
Phoenix, AZ 85072-2033
Provider Resources
Change Healthcare Client Resource Guide
No Surprises Act (NSA) Information