Claims and Remits
In addition to claim status and online remit tools, we offer resources to help you understand requirements for claim submission, coding, and pricing.
- Claim Adjustments-Provider Operating Guide Section 19 19 Claim Submission Provider Operating Guide Claim submission
You can submit claim electronically via the Availity Essentials™ Portal at “Claims & Payments > Claims > Claims & Encounters”
Claim adjustment
Claim Submission Guidelines (AZ Blue Provider Operating Guide Section 19)
HIPAA Transaction Standard-AZ Blue Companion Guide
You can submit claim adjustments electronically via the Availity Essentials Portal
Correcting a provider NPI
Note: Go to “Claims & Payments > Claims > Claims & Encounters.” In the Claim Information section, under Frequency Type, select 7-Replacement of Prior Claim. Then enter the original claim number. Continue to complete the form to mimic the original claim with the exception of the information being corrected.
Claim Adjustments – Excerpt from AZ Blue Provider Operating Guide
Electronic Claim Adjustments Guide
If you are correcting a provider NPI, please use our corrected claim form and include medical record documentation verifying the rendering provider.
TYPE OF PLAN HOW TO ACCESS AZ Blue Plans
FEP Plans
BlueCard (Out-of-Area) PlansACA StandardHealth with Health Choice Plan (prefix IAZ)
Medicare Advantage Plans (prefix M2K)
For plans administered by AZ Blue: Availity Essentials Portal
Other plan administrators:
Arizona Priority Care (AZPC)
Optum Health Network Arizona (OHNAZ)
Corporate Health Services (CHS) Group Plans (no prefix)
Contact the third-party administrator (TPA) named on the member ID card or use our search tool to find the TPA contact information:
CHS Group - TPA Information Finder BlueDentalSM Stand-Alone Plans (prefix 99D)
Access this content via the Availity Essentials portal (AZ Blue Payer Space).TYPE OF PLAN HOW TO ACCESS AZ Blue Plans
Federal Employee Program® (FEP®) Plans
BlueCard® (Out-of-Area) Plans
Medicare Advantage PlansACA StandardHealth with Health Choice Plan (prefix IAZ)
Corporate Health Services (CHS) Group Plans (no prefix)
Contact the third-party administrator (TPA) named on the member ID card or use our search tool to find the TPA contact information:
CHS Group - TPA Information Finder BlueDental Stand-Alone Plans (prefix 99D)
Access this content via the Availity Essentials portal (AZ Blue Payer Space).Claim Coding Resources (PDF)
Clear Claim Connection (C3) User Guide (PDF)
Clear Claim Connection (C3) Transparency Tool
Claim Coding-AZ Blue Provider Operating Guide Section 18 (PDF)
Code Edit Guidelines (PDF)
Outpatient Coding Guide (select edition below)
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Access this content via the Availity Essentials portal (AZ Blue Payer Space).-
All content below may be accessed only by contracted providers via the Availity Essentials portal (AZ Blue Payer Space).
Claim Pricing (AZ Blue Provider Operating Guide Section 20)
FEES OUTPATIENT GLOBAL PRICING OTHER PROPRIETARY PRICING GUIDELINES
