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Electronic Transactions

Arizona Complete Health is working hard to make claims procedures easier for providers. Arizona Complete Health' Electronic Data Interchange (EDI) solutions make it easy for more than 125,000 in our national provider network to submit claims electronically. Whether on-line, through your practice management system, vendor or direct through a data feed, EDI ensures that your claims get submitted quickly.

Instead of cumbersome paper forms and time consuming mailings, you can generally submit claims in just a few moments. With the click of a mouse or a keystroke, claims can be sent electronically. You can also submit via EDI any time, making it easier to attend to patient priorities. For our complete list of Electronic Clearing House Vendors please visits the Electronic Transactions page.

Get Started

For successful EDI claim submission, you'll need to use electronic reporting made available by your vendor and clearinghouse. View our approved vendor list and corresponding payer ID numbers below. Please reach out to your own vendor on connecting through one of these channels. Arizona Complete Health returns claims acknowledgments back to the clearinghouse with notifications of acceptance or rejections of individual claims. Providers can review these reports to check the status of their submission.

If you have not met your assigned Provider Engagement Specialist or do not have their contact information please email AzchProviderEngagement@azcompletehealth.com to obtain this information.

Arizona Complete Health has further streamlined our business processes to improve claims procedures. Providers can now register to receive Electronic Remittance Advices (ERA). These features streamline claim processing, reduce administrative work and improve provider satisfaction by reducing claims-related problems.

ERA files give providers details regarding multiple claims. ERA improves providers' business office workflow by allowing the adjudicated claim information to be automatically posted to accounts receivable systems. Arizona Complete Health will send an ERA to any provider who registers with Arizona Complete Health and with a clearinghouse. ERA is available in all Arizona Complete Health service areas.

Electronic Funds Transfer (EFT) automates the distribution of funds into providers' accounts using Automated Clearinghouse (ACH) processing. EFT is the electronic mechanism used to instruct Depository Financial Institutions (DFIs) to move money from one account to another. Many formats are available for the actual data in the electronic message, and different formats apply at each stage. EFT is safe, secure, efficient, and less expensive than paper check payments and collections. 

Benefits include:

  • Elimination of paper checks – all deposits transmitted via EFT to the designated bank account
  • Convenient Payments & Retrieval of remittance information
  • Electronic remittance advices presented online
  • HIPAA 835 electronic remittance files for download directly to a HIPAA-Compliant Practice Management for Patient Accounting System
  • Reduce accounting expenses – Electronic remittance advices can be imported directly into practice management or patient accounting systems, eliminating the need for manual re-keying
  • Improve cash flow – Electronic payments can mean faster payments, leading to improvements in cash flow
  • Maintain control over bank accounts – You keep TOTAL control over the destination of claim payment funds.  Multiple practices and accounts are supported
  • Match payments to advices quickly – You can associate electronic payments with electronic remittance advices quickly and easily
  • Manage multiple Payers – Reuse enrollment information to connect with multiple Payers Assign different Payers to different bank accounts, as desired

Learn more about how to register for PaySpan (PDF).

Visit PaySpan’s website for more information: www.payspanhealth.com

Secure Web Portal

Partial list of secure website functions include verify member eligibility, check/submit claims and submit/confirm authorizations.

EDI

Electronic Transactions (EDI) support for HIPAA transactions is provided for the health plan by Centene Corporation. Centene is currently receiving professional, institutional, and encounter transactions electronically, as well as generating an electronic remittance advice/explanation of payment (ERA/EOP). To conduct other HIPAA transactions not listed, please contact our EDI department at 1-800-225-2573, ext. 25525 or by email at EDIBA@centene.com.

Electronic Data Interchange (EDI) is the exchange of business transactions in a standardized format from one computer to another. Arizona Complete Health and providers use this technology to communicate claims, electronic remittance, claims payment, eligibility and other information, providing a paperless and efficient process.

EDI also gives you the tools you need to track electronic claims status on-line, prove timely filing and access to daily accept/reject reports. This also means easier receivables and account reconciliation. By using Arizona Complete Health-approved vendors and clearinghouses, HIPAA compliance is done for you and you'll have automatic access to highly secure and time-tested solutions.

Arizona Complete Health has the following transactions available for providers through our approved clearinghouses: 837 electronic claim submission, 835 electronic remittance advice, real time eligibility (270/271) and real time claims status (276/277) transactions. We are CORE Phase II certified with our real time claims status and member eligibility transactions as well as compliant with the Federal Operating rules. EFT (electronic funds transfer) is also available with online registration via our website or downloadable forms to be sent via secure fax.

The benefits of electronic claim submission includes:

  • Reduction and elimination of costs associated with printing and mailing paper claims
  • Improvement of data integrity through the use of clearinghouse edits
  • Faster receipt of claims by Arizona Complete Health, resulting in reduced processing time and quicker payment
  • Confirmation of receipt of claims by the clearinghouse
  • Availability of reports when electronic claims are rejected and ability to track electronic claims, resulting in greater accountability
  • HIPAA 835 electronic remittance files for download directly to a HIPAA-Compliant Practice Management for Patient Accounting System

Reports

For successful electronic data interchange (EDI) claim submission, participating providers must utilize the electronic reporting made available by their vendor or clearinghouse. There may be several levels of electronic reporting:

  • Acceptance/rejection reports from EDI vendor
  • Acceptance/rejection reports from EDI clearinghouse
  • Acceptance/rejection reports from Health Net Access

Providers are encouraged to contact their vendor/clearinghouse to see how these reports can be accessed/viewed. All electronic claims that have been rejected must be corrected and resubmitted. Rejected claims may be resubmitted electronically.

Providers may also check the status of paper and electronic claims online at on the Secure Provider Portal.

We work with the following clearinghouses:

Clearinghouse chart

Clearinghouse/ Direct Submitter

Arizona Complete Health’s Payer ID (Medicaid, Medicare and Exchange)

Ability

68069

Allscripts

68069

Availity

68069

ClaimRemedi

68069

Claimsource

68069

Emdeon/Capario

68069

First Health

68069

Gatewayedi/Trizetto

68069

Great Expectations

68069

Greenway

68069

IGI

68069

Mckesson/Relay

68069

Netwerkes

68069

Physicians CC

68069

Practice Insight

68069

Smart Data Solutions

68069

SSI

68069

Viatrack

68069

Zarepathj

68069

Zirmed

68069