Electronic Transactions

Arizona Complete Health has further streamlined our business processes to improve claims procedures. Providers can now register to receive Electronic Remittance Advices (ERA). These features streamline claim processing, reduce administrative work and improve provider satisfaction by reducing claims-related problems.

ERA files give providers details regarding multiple claims. ERA improves providers' business office workflow by allowing the adjudicated claim information to be automatically posted to accounts receivable systems. Arizona Complete Health will send an ERA to any provider who registers with Arizona Complete Health and with a clearinghouse. ERA is available in all Arizona Complete Health service areas.

Electronic Funds Transfer (EFT) automates the distribution of funds into providers' accounts using Automated Clearinghouse (ACH) processing. EFT is the electronic mechanism used to instruct Depository Financial Institutions (DFIs) to move money from one account to another. Many formats are available for the actual data in the electronic message, and different formats apply at each stage. EFT is safe, secure, efficient, and less expensive than paper check payments and collections. 

Benefits include:

• Elimination of paper checks – all deposits transmitted via EFT to the designated bank account
• Convenient Payments & Retrieval of remittance information
• Electronic remittance advices presented online
• HIPAA 835 electronic remittance files for download directly to a HIPAA-Compliant Practice Management for Patient Accounting System
• Reduce accounting expenses – Electronic remittance advices can be imported directly into practice management or patient accounting systems, eliminating the need for manual re-keying
• Improve cash flow – Electronic payments can mean faster payments, leading to improvements in cash flow
• Maintain control over bank accounts – You keep TOTAL control over the destination of claim payment funds.  Multiple practices and accounts are supported
• Match payments to advices quickly – You can associate electronic payments with electronic remittance advices quickly and easily
• Manage multiple Payers – Reuse enrollment information to connect with multiple Payers Assign different Payers to different bank accounts, as desired

Learn more about how to register for PaySpan (PDF).

Visit PaySpan’s website for more information: www.payspanhealth.com

Electronic Data Interchange (EDI) is the exchange of business transactions in a standardized format from one computer to another. Arizona Complete Health and providers use this technology to communicate claims, electronic remittance, claims payment, eligibility and other information, providing a paperless and efficient process.

EDI also gives you the tools you need to track electronic claims status on-line, prove timely filing and access to daily accept/reject reports. This also means easier receivables and account reconciliation. By using Arizona Complete Health-approved vendors and clearinghouses, HIPAA compliance is done for you and you'll have automatic access to highly secure and time-tested solutions.

Arizona Complete Health has the following transactions available for providers through our approved clearinghouses: 837 electronic claim submission, 835 electronic remittance advice, real time eligibility (270/271) and real time claims status (276/277) transactions. We are CORE Phase II certified with our real time claims status and member eligibility transactions as well as compliant with the Federal Operating rules. EFT (electronic funds transfer) is also available with online registration via our website or downloadable forms to be sent via secure fax.

The benefits of electronic claim submission includes:

• Reduction and elimination of costs associated with printing and mailing paper claims
• Improvement of data integrity through the use of clearinghouse edits
• Faster receipt of claims by Arizona Complete Health, resulting in reduced processing time and quicker payment
• Confirmation of receipt of claims by the clearinghouse
• Availability of reports when electronic claims are rejected and ability to track electronic claims, resulting in greater accountability
• HIPAA 835 electronic remittance files for download directly to a HIPAA-Compliant Practice Management for Patient Accounting System

Reports

For successful electronic data interchange (EDI) claim submission, participating providers must utilize the electronic reporting made available by their vendor or clearinghouse. There may be several levels of electronic reporting:

• Acceptance/rejection reports from EDI vendor
• Acceptance/rejection reports from EDI clearinghouse
• Acceptance/rejection reports from Health Net Access

Providers are encouraged to contact their vendor/clearinghouse to see how these reports can be accessed/viewed. All electronic claims that have been rejected must be corrected and resubmitted. Rejected claims may be resubmitted electronically.

Providers may also check the status of paper and electronic claims online at on the Secure Provider Portal.