Tracer, Review or Corrected Claim – Which terminology is correct?

Arizona Foundation receives claims noted as “tracer”, “review” and “corrected claim”. What do these terms mean? Interpretation can vary, however, to a network or plan administrator, they mean the following.

Tracer

A “tracer” claim is a claim that is being resubmitted because payment has not yet been received. In order for Arizona Foundation to research these claims and resend them to the plan administrators more efficiently, please use the term “tracer”.

You may research these claims online at http://www.azfmc.com, login under “Provider” and go to “Claim Status”. You will be able to view the repriced claim and print the Explanation of Review (EOR). You will also be able to see the date that the claim and repricing sheet was sent to the plan administrator for payment (reference “EOR Date” in upper left hand corner).

Review

A “review” claim is reserved for claims where there is a dispute regarding an Arizona Foundation denial or allowed amount. For physicians, these claims should be directed to Arizona Foundation’s Medical Review department for handling.

Disputes regarding claims regarding actual payments, benefits, and denials by the plan administrator should be directed to the plan administrator, as Arizona Foundation does not pay claims nor have this information.

Corrected Claim

A “corrected claim” is a claim that is being resubmitted because something has changed on the claim or being added to the original claim. This would include, but not limited to, diagnosis codes, CPT codes, and ICD-9 codes.