Arizona Complete Health Timely Filing Limit

Arizona Complete Health's first published filing rule in the reviewed sources is: Medicaid / Arizona Complete Health-Complete Care Plan: 120 days effective 3/1/2019; 180 days prior to 3/1/2019.. Confirm the plan, provider agreement, and event that starts the filing period before submission.

At a glance

• Timely filing varies by line of business. Official claims/payment guidance states Medicaid initial paper claim submissions are timely at 120 days effective 3/1/2019 (and 180 days prior to that date), Ambetter initial submissions are 120 days, and Medicare initial submissions are 180 days. Corrected claims for the Medicaid/Arizona Complete Health-Complete Care Plan line must be received within 12 months from date of service or date of eligibility posting, whichever is later. Provider claim disputes/reconsiderations also have 12-month / 60-day timing rules, depending on the step and triggering event.

Initial claim filing limits

• Medicaid / Arizona Complete Health-Complete Care Plan: 120 days effective 3/1/2019; 180 days prior to 3/1/2019.
• Ambetter from Arizona Complete Health: 120 days.
• Wellcare by Allwell / Medicare: 180 days.

Corrected claim filing limits

• Corrected claim must be received no later than 12 months from the date of services or 12 months after the date of eligibility posting, whichever is later.
• If an initial claim requires correction, the corrected claim must be submitted within twelve months after the date of service or date of eligibility posting, whichever is later.

Appeal and reconsideration deadlines

• Medicaid provider claim reconsiderations: within 12 months of the date of service.
• Medicaid provider claim disputes: later of 12 months after date of delivery/service, 12 months after eligibility posting, or 60 days after payment/denial of a timely claim submission or recoupment.
• If a provider claim dispute decision is unfavorable, the provider has 30 days from receipt of the notice to request a state fair hearing.

Trigger basis and caveats

• The official dispute rules use different trigger bases depending on the pathway: date of service/date of eligibility posting for reconsiderations/corrected claims, and payment/denial/recoupment timing for formal disputes.
• The claims/payment page notes that corrected claims are commonly used for denials related to timely filing, incorrect coding, units, or bill type.
• Timely filing appears to vary materially by line of business and document set; provider contracts may override general guidance.
• Some older PDFs on the site may contain legacy values, so current webpage guidance was preferred where available.

Provider resources

• Provider Portal Login (official)
• Prior Authorization (official)
• Claims and Payment (official)
• Remittance Advice (official)
• Electronic Transactions (official)
• Medicaid Provider Claim Resolution Process (official)
• Arizona Complete Health Transition to Availity Essentials (official)

Sources