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Online Claim Status
AFMC has made a special commitment to payors to ensure that they have all the tools necessary to streamline their day-to-day business operations. To that end, AFMC has created the Claim Status Review.
The Claim Status Review allows payors to print AFMC's Explanation of Review (EOR) reducing the time spent on claim repricing research. To gain access to your claim status information click on the following link: Claim Status
You will be asked to sign in for general admittance to the proprietary information found in this area. If you are not already registered, please follow the registration instructions to set up your account.
Once you have registered, please send an e-mail with “Payor Claim Status" in the subject line.
The body of the e-mail should include all contact names, e-mail addresses and phone number of people within your company that should have access to this PHI (Personal Health Information). You will receive an e-mail notification when your request is processed.
Note: Persons with payor claim access will need to renew their access every 90 days.
Should you have any questions, please call 800-624-4277 or e-mail.
AFMC Providers Require Timely Payment
As stated in your contract with Arizona Foundation for Medical Care (AFMC), Payors that have groups who utilize AFMC hospitals must adhere to a strict payment schedule to earn hospital discounts. To earn the discount, a claim must be paid within thirty (30) calendar days of the date all information from AFMC, its participating or contracting providers, which is necessary for processing the claim, is received by the payor or its designate.
In addition, AFMC physician contracts include a statement that in the event of payment or notification of claims status is not received within ninety (90) days after submission of claim(s), the physician has the right to bill the insured person or covered dependent for services rendered. |
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Prepare for 5010 Today!
Protect and strengthen your organization's relationship with Arizona Foundation for Medical Care.
On January 1, 2012, a federal mandate requires health plans, clearinghouses and providers to use new standards in electronically conducting certain healthcare administrative transactions at the heart of daily operations, including claims submission and status requests and responses.
The deadline is approaching fast. Now is the time for effected healthcare organizations to upgrade and test their claims management systems to accommodate 5010 and prevent operational disruptions.
AFMC has prepared a Q & A document to answer your immediate questions and concerns regarding functionality with us: Download and print a copy.
Read AFMC’s Q & A Document
Read AFMC’s Companion Guide.
The Version 5010 Compliance Deadline is Less Than 90 Days Away!
All entities covered under the Health Insurance Portability and Accountability Act (HIPAA) must be ready to implement the Version 5010 transaction standards by December 31, 2011. In order to meet this compliance deadline, you need to conduct both Level I Internal Testing, and Level II External Testing of transactions.
Level I Internal Testing
Level I Internal Testing allows you to identify and address any potential issues that may arise in advance of testing with external business partners. If you have not yet done so, take action now to complete your internal testing as soon as possible. By now, you should have completed Level I Internal Testing, and begun Level II External Testing.
Level II External Testing
For Level II External Testing, you should identify the business partners you currently conduct transactions with, and create a schedule and timeline for external testing with each partner. If you trade with a large number of business partners, identify priority partners to conduct testing with first.
To meet Level II compliance, business partners that should be included in external testing include:
• Billing services
• Clearinghouses
• Pharmacies
• Entities responsible for coverage and benefit determinations
• Payers
To ensure a smooth transition during Level II External Testing, you should first test the transactions you currently use on a daily basis, such as:
• Claims
• Eligibility determinations
• Remittances
• Referral authorizations
After testing your daily transactions, you are ready to test all remaining transactions to ensure that you are fully compliant for Level II External Testing.
Keep up to date on Version 5010 and ICD-10. Visit the ICD-10 Web site for the latest news and resources to help you prepare.
Some of the links below are pdfs. You must have the latest version Adobe Reader installed on your computer to view these files.
Your Checklist for Good Health! What can you do to stay healthy and prevent disease? You can get certain screening tests, take preventive medicine if you need it, and practice healthy behaviors. Men's Checklist. Women's Checklist.
Learn about HearPO, a hearing care discount program for your clients that makes hearing-aid services accessible, as well as affordable.
Pre-cert 101 - Everything you wanted to know about AFMC's Pre-cert process, but condensed down in an easy-to-use flyer.
How to Create a Custom Directory and Search for Providers - These applications let you search and create a customized listing of facilities and/or practitioners participating in AFMC's Network.
Enrollment Upload - Upload new groups or members.
Renewal Form - Is it time for your client to renew their contract with AFMC? Do you want to inquire about their rates for the new contract? Use the Renewal Rates Form.
Medical Management Programs and Wellness Services - To help control the rising cost of healthcare, AFMC - through our strategic partnerships - has compiled a comprehensive package of Medical Management Services and Wellness Programs.
Convenience Clinics - An alternative to urgent care centers, convenience clinics diagnose and treat a variety of common illnesses and minor injuries for patients 18 months and older. They also offer wellness and preventive services and vaccinations.
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