Claims
Electronic Data Interchange (EDI)
At BCBSAZ 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. BCBSAZ 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 | 866-742-4355 | HCFA 1500 – Professional (837P) UB 92 and UB 04 – Institutional (837I) Claims Status Inquiry/Response (276/277) | 62179
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Change Healthcare | 866-742-4355 | Electronic Remittance Advice (835) | 62179
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Change Healthcare | 866-742-4355 | Eligibility Inquiry and Response (270/271) Claims Status Inquiry/Response (276/277) | HCOAZ |
Dental Providers
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.
Getting a National Provider Identifier (NPI)
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:
NPI Enumerator
P.O. Box 6059
Fargo, ND 58108-6059Phone
1-800-465-3203 TTY/TTD users call 711
Timely filing
NON-CONTRACTED PROVIDERS:
Initial Claim: 6 months from the date of service (If HCP is primary, the claim timeliness changes to 7-months from the date of service or eligibility date).
Corrected Claim: 12 months from the date of service.
CONTRACTED PROVIDERS
Initial Claim: 6 months from date of service or PPC (If HCP is primary, the claim timeliness changes to 7-months from the date of service or eligibility date)
Corrected Claim: 12 months from the date of service.
Claim Submissions | 6 Mos from DOS (end) | 6 Mos from DOS (end)
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Claim Re-submission
| 12 Mos from DOS (end) | 12 Mos from DOS (end)
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Dispute | 60 Days from Date of Claim Determination OR 12 Mos from DOS (end) | 60 Days from Claim Determination OR 12 Mos from DOS (end) |
Second Level Dispute | 30 Calendar Days after Dispute Decision | 30 Calendar Days after Dispute Decision
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Mailing Address for Paper Claims:
BCBSAZ Health Choice
P.O. BOX 52033
PHOENIX, AZ 85072-2033
Call Us
CRISIS HELP: 1-844-534-HOPE (4673) or Text 4HOPE (44673)
24/7 Nurse Advice Line: 1-888-267-9037
Call Us: 1-800-322-8670 (TTY:711)