Claim Submissions and Coordination of Benefits
Health Choice Generations maintains a network of contracted providers to ensure continuity of care for our members. Please utilize contracted providers when referring members for care, as failure to do so may result in denial of claim payment.
For a full list of contracted providers and/or a contracted provider finder application is located under the Find a Doctor/Pharmacy tab.
Following are some of the most frequently asked questions and answers regarding claims submission and coordination of benefits.
Where should Plan Providers send their Claims?
Medical Claims
Health Choice Generations
410 N. 44th Street, Ste. 510
Phoenix, AZ 85008
Pharmacy
Express Scripts
PO Box 66583
St. Louis, MO 63166
Which Provider ID # should be used on the Claim Form for Health Choice Generations
Providers may use their Medicare/UPIN number in Box 33 or continue to use the AHCCCS Provider ID as currently used when billing Health Choice.
Effective January 1, 2007, Health Choice will allow the option to submit claims using the National Provider Identifier (NPI), however, effective May 23, 2007, all claims are required to submitted with the NPI. More information on NPI is available at http://www.cms.gov/NationalProvIdentStand/.
Providers currently contracted with Health Choice may mail or fax written notification of their NPI number to the Network Services.
Health Choice Arizona Attention:
Network Services
410 N. 44th Street, Ste. 900
Phoenix, AZ 85008
Maricopa and Pinal Counties...............Fax: 480-303-4433
Pima County.......................................Fax: 520-322-5784
Apache/Navajo/Coconino Counties.....Fax: 928-532-0824
How may I check Claims Status or Claims Inquiry?
Providers can visit the Health Choice Generations Web site at www.hcgenerations.com to review claims and check member eligibility. Providers must pre-register on-line prior to having access to this confidential information. After you have registered, you will be able to view only your member's claim information. Should you have difficulty registering you may refer to the Log-in Tutorial.
Providers may also call Health Choice Generations Claims Customer Service or Member Services for eligibility at 1-800-322-8670.
Who is the Primary payor: Health Choice Generations or Health Choice Arizona?
Health Choice Generations (Medicare) is the primary payor and submits the encounter directly to Health Choice Arizona (Medicaid) for processing of the secondary payment. Providers do not have to submit two claims to each Plan. However, Providers will receive two explanation of Benefits (EOB), one EOB reflects the Medicare allowable and the second EOB will show processing of any secondary amount under the Medicaid (AHCCCS) program. If Health Choice Arizona is not the secondary payor, then the primary EOB must be submitted to the secondary payor by the Provider.
Provider Accounts Receivable
Health Choice does not reconcile accounts receivable for provider offices. It is the responsibility of the provider office to ensure that payments are properly posted and that claims are resubmitted with proper/requested information in a timely manner. Enclosed is a Health Choice Generations denial glossary to assist you in reconciling your receivables.
Members
