If you have received a claim payment for services in-scope for the NSA, please note the following information and disclosures:
1. BCBSAZ processes claims in compliance with the NSA. According to the NSA, the recognized amount in Arizona is the lesser of the qualifying payment amount (QPA) or billed charges, and is determined according to a specific formula. BCBSAZ bases member cost share on the “lesser of” amount.
2. BCBSAZ will typically use the lesser of the qualifying payment amount (QPA) or billed charges as the allowed amount for each claim line. BCBSAZ will generally base its initial payment on the “lesser of” amount, minus member cost share.
Please note: For air ambulance claims and any other claims where BCBSAZ determines that the QPA calculation does not represent fair value for the service rendered, the basis for the initial payment amount may vary from the QPA.
3. The provider has the right, within 30 business days from the date of claim payment or denial, to ask for open negotiation about the initial payment amount, using one of the following negotiation request forms:
- BCBSAZ form (This complies with the U.S. Department of Labor form, includes information we need to identify your claim, and is fillable for your convenience.)
- Department of Labor info/form (If you use this form, you must also send the information required on the BCBSAZ form, including the patient name, member ID, and claim number.)
4. You may send your completed request form, along with a copy of your remit, to our negotiation team at NSArequest@azblue.com.