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Q: How do I submit a precertification request through AFMC?
A: To submit a precertification request online, use your Login and password to access the precertification request form. You may also contact Foundation CHOICE at (602) 252-4042, toll free (800) 624-4277.
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: Who do I contact to obtain a precertification (or preauthorization) for hospital admissions, services at an outpatient facility or ambulatory surgery center?
A: Check the patient's ID card to obtain the contact information for precertification services.
Q: How large is the provider network?
A: There are nearly 13,000 physicians with over 31,000 locations in AFMC's network.
Q: How long does it take to process a claim?
A: AFMC reprices clean claims in 1.5 days.
Q: Is AFMC compliant with current HIPAA regulations?
A: Yes, AFMC is HIPAA compliant.
Q: Where are patient claims sent?
A: In most cases, claims are sent directly to AFMC first to be repriced. However, there are a few exceptions. Please check your patient's ID card for this information. A complete Listing of Administrators containing this information is also available on this website.
Q: Where can I find a list of insurance carriers that partner with AFMC?
A: A detailed listing of carriers that work with AFMC can be found in The Guide to Arizona Foundation Fully Insured and Self-Funded Plans located on this website.
Q: Who do I call regarding questions about my hospital or physician contract with AFMC?
A: Contact AFMC's Marketing & Network Management department at (800) 624-4277. Or, you can email AFMC directly through Contact Us.
Q: How can I obtain a new provider directory?
A: You can order an AFMC provider directory online. Within the Provider category, refer to the Directory Request option, then complete and submit the directory order form.
Q: Is there a reference tool available containing everything I need to know as an AFMC provider?
A: Yes, AFMC's Provider Reference Guide has been developed to help educate our providers on AFMC's general policies and procedures. It is available on this website.
Q: If I participate in the Foundation Regional network, how can I search for providers?
A: Clicking on Foundation Regional will take you to their Web site.
NOTE: Members do not automatically have access to these networks when using AFMC's Arizona network. Contact AFMC to verify access first. It is also recommended that a provider's network status be confirmed by calling the number printed on the member's ID card.
Q: How do I check the payment status of a claim?
A: To check payment status, contact the patient's Plan Administrator; AFMC does not pay claims nor administer benefits. Call the phone number for Benefits and Eligibility listed on the patient's ID card. 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: 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: Who do I contact for benefit information?
A: Contact the patient's Plan Administrator for this information. Call the phone number for Benefits and Eligibility listed on the patient's ID card.
Q: How do I join the AFMC network?
A: Individual physicians, group practices/organizations, and/or facilities may join the network by completing the initial request form.
Upon receipt, AFMC’s Marketing & Network Management Department will contact you to start the application process. Please allow five (5) business days for AMFC to process your request before contacting us by e-mail to networkmanagement@azfmc.com
Q: What is the procedure for appealing a physician or hospital claim?
A: The Claim Appeal option is available online to all AFMC physicians and facilities. Just complete the Claim Appeal Form and Submit with all supporting documentation. Your appeal will be sent directly to AFMC Network Management for review.
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 in 2009!
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.
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 providers, 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 allowing AFMC to maintain our competitive edge in the marketplace.
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