Arizona Complete Health Timely Filing Limit

The most important thing to confirm with Arizona Complete Health is not just the number of days, but also what event starts the clock. Some payer documents measure from date of service, some from discharge, and some publish different rules for corrected claims or appeals.

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