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| Frequently Asked Questions |
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Q: How long has the Arizona Foundation for Medical Care (AFMC) network been in Arizona?
A: AFMC has been a PPO managed care network since 1969. We are celebrating 40 years of business in 2009!
Q: How many payors are contracted with AFMC?
A: AFMC is contracted with over 100 Carriers and Third Party Administrators.
Q: Can AFMC accommodate employer groups with members outside of Arizona?
A: Yes, AFMC is a founding partner of VentureNet Healthcare, a regional coalition of four healthcare networks who have come together to offer members and corporate clients boundless access to high-quality, affordable healthcare across an eight state region.
By joining together to form this new entity, VentureNet Healthcare will be able to provide its members with access to more than 93,000 providers, 670 hospitals and 10,000 ancillary services across an eight state region including Alaska, Arizona, California, Idaho, Montana, Nevada, Oregon, Southwest Washington. This vast network will provide businesses that have multi-state operations in this region with a healthcare benefits packages that allows its members to access high-quality care anywhere in the region.
For more information about VentureNet Healthcare or for estimates on custom heath plans available for your clients, please call AFMC's Senior Sales Consultants at 602-252-4042, 800-624-4277, or e-mail them at info@venturenethc.com. Or, visit VentureNet Healthcare's Web site at www.VentureNetHC.com.
Q: How large is the provider network?
A: There are nearly 13,000 physicians with over 31,000 locations in AFMC's network.
Q: In what timeframe are the AFMC providers contracted?
A: AFMC providers are contracted on a calendar year basis (1/1 - 12/31). Providers contractually agree to remain in the AFMC network for the entire year ensuring network stability and continuity of care for members.
Q: What is the AFMC provider renewal rate?
A: 98% of our participating providers renew each year.
Q: How are claims paid?
A: AFMC doesn't pay claims but reprices claims in accordance with a pre-determined fee schedule. Claim payment is made by the Plan Administrator.
Q: Who determines AFMC's physician fee schedule.
A: AFMC's discount structure is determined through contract negotiations with hospitals, surgical facilities, ancillary provides, and by an Independent Reimbursement Committee (IRC) that is responsible for setting the professional fees paid to physicians. The IRC is comprised of representatives that are elected each year from employer groups using AFMC endorsed or sponsored plans and three non-member physicians. The Committee meets several times a year to review, amend, and set procedure allowances enabling AFMC to maintain our competitive edge in the marketplace.
Q: How are claims processed?
A: Over 75% of claims are auto-repriced electronically.
Q: How long does it take to process a claim?
A: AFMC reprices clean claims in 1.5 days.
Q: How do I check the status of a claim?
A: To check repricing status online, use your login and password to access your proprietary information. Refer to the Claim Status option and complete the required fields.
Q: Does AFMC have a Medical Management Package?
A: AFMC has a total Medical Management Package that includes Utilization, Case, and Disease Management in addition to wellness programs. Please contact an AFMC Sales Consultant at 602-252-4042 or 800-624-4277 or through the Contact Us link for more information.
Q: Is AFMC compliant with current HIPAA regulations?
A: Yes, AFMC is HIPAA compliant.
Q: Where can I find a list of AFMC rates?
A: For a current Schedule of AFMC Rates & Services, contact your AFMC Senior Sales Consultant. They can be reached at (602) 252-4042 or (800) 624-4277.
Q: Where do I direct marketing-related requests for information such as RFP's, RFI's and Geo Access Reports?
A: These requests can be directed to the attention of Marketing & Network Management at marketing@azfmc.com or your AFMC Senior Sales Consultant
Q: Can I upload enrollment and obtain the most current AFMC provider updates through the website?
A: Yes, use your login and password to upload this proprietary information. Refer to the Enrollment and Provider Update options and complete the required fields.
Q: Can claims be sent electronically to AFMC?
A: Claims can be submitted electronically using the services of a clearinghouse or directly to AFMC. To send directly to AFMC, submit a request to AFMC's IS Department at cedi@azfmc.com and a representative will email the appropriate implementation materials.
Q: How do I set up my user ID and password?
A: If the option you select requires a Login, a screen will appear asking you to either login or register. If you have not yet registered, follow the steps for registration. Keep your User ID and password in a safe place for future reference. It will allow you to access your proprietary information.
Q: How can I verify that a physician is an AFMC provider?
A: Use the Provider Search option on this website or call the AFMC at (602) 252-4042 or (800) 624-4277 and follow the "payor" automated attendant prompts. The Payor Unit is also available to assist you with any day-to-day needs.
Q: How can I find a listing of doctors or facilities in a specified area?
A: Use the Provider Search option on this Web site.
Q: How can I obtain new provider directories for my clients or for marketing AFMC plans?
A: You can order a provider directory online using the Directory Order Form.
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