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Important Information about Your AFMC Contract Application
Providers: Please remember to make a photo copy of your AFMC contract application prior to submission. Because this is your legally, binding contract with AFMC, it is imperative you retain a copy for your records.
Should you have any questions, please contact AFMC's Network Management Department by calling 800-624-4277 or e-mail to networkmanagement@azfmc.com.
Ever Wonder How AFMC Sets It’s Reimbursement Rates? Then read on...
AFMC’s Fee Schedule is set by the Reimbursement/Fee Committee, which is comprised of seven non-AFMC member physicians and employer group representatives that are utilizing AFMC’s Network Plans. The Committee meets several times each year and its responsibility includes reviewing, amending and setting the procedure allowances that comprise the maximum reimbursement fee schedules utilized by AFMC.
The Fee Schedule is based upon an allowable amount for each Current Procedural Terminology (CPT) code. AFMC fees are designed to produce fair market rates for providers and employers and to be competitive. AFMC uses a composite of statewide industry data and third party resources (relative value scales, etc.) when establishing provider or facility rates. The schedule is evaluated several times a year against market and industry pricing.
Physician members agree to accept the Fee Schedule as payment in full for covered services rendered to their patients (AFMC members). Because AFMC is a not-for-profit service to the community, they do not receive any portion of fee adjustments. |
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New HIPAA "5010" Standard Transactions and ICD-10 Code Sets
On January 16, 2009, the Department of Health and Human Services (HHS) announced that an updated version of the HIPAA standards will be required for use starting on January 1, 2012. The updated version of these standards are referred to as 5010. Also announced by HHS was the requirement to move from use of ICD-9 to ICD-10.
The AMA has prepared several educational resources to assist providers with implementing the aforementioned standards, including fact sheets, AMA's Advocacy on behalf of Providers, and educational resources. Click on the links above to view information on that topic or visit the AMA Web site.
Make Sure Your Practice is Compliant with the New Health Privacy and Security Requirements
Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the American Recovery and Reinvestment Act of 2009 (ARRA), physicians are required to control the ways in which they use and disclose patients' protected health information. The American Medical Association's Practice Management Center has put together 'What you need to know about the new health privacy and security requirements", which outlines the newly expanded requirements for protection of patient health information; patient rights to this information; and administrative protections physicians must have in place. Learn about the compliance deadlines and where you can find more information to ensure your practice is fully protecting your patients' health information.
The links below are pdfs. You must have the latest version Adobe Reader installed on your computer to view these files.
AFMC Fee Schedule Request
Provider Change Form
Privacy Notice Form
How to Use Provider Search/Custom Directory Functions
Provider ID Card 101
Network Plan Definitions
Claims 101
Glossary for Providers
AFMC Call Center agents cannot appeal a claim on your behalf. Should you need to appeal a medical or hospital claim, please utilize AFMC’s on-line appeal function. Click on the “Provider” link on the left hand side of the page, then the “Claims Appeal” sub-link. You may also send your appeal by mail to:
Arizona Foundation for Medical Care
P.O. Box 2909
Attention: Medical Review
Phoenix, Arizona 85062-2909
If you need to appeal a hospital claim, please mail your claim to the address above “Attention: Hospital Appeals”.
Please note: If you are submitting an appeal based on pricing, please send it to AFMC. If you are appealing a paid claim, you must send your appeal to the Payor. For a complete listing of AFMC payors and their contact information, utilize AFMC’s Listing of Administrators; simply click on the link to your left and follow the prompts.
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