Reminder: Billing for Care1st Members that Transition to Arizona Complete Health-Complete Care Plan (AzCH-Complete Care Plan)

Date: 09/24/21

Dear AzCH-Complete Care Plan Provider and Billing Team,

Effective October 1, 2021, 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	57116 or 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: You must register separately with PaySpan for AzCH-Complete Care Plan.  If you are newly contracted with AzCH-Complete Care Plan please don’t forget to 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 Manual by visiting www.azcompletehealth.com/ > For Providers > Provider Resources > Manuals and Forms > Arizona Complete Health-Complete Care Plan Online Provider Manual. 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