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 Availity to make the electronic claims submission process as seamless as possible. BCBSAZ Health Choice is fully 5010-compliant. You can enroll with Availity at Availity Essentials.
Availity | Professional (837P) Institutional (837I) Dental (837D) Eligibility Inquiry and Response (270/271) Claims Status Inquiry/Response (276/277) Electronic Remittance Advice (835) | RP105 |
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