Care1st Health Plan Arizona

Filing a claim

Electronic Data Interchange (EDI)

We strongly encourage you to submit your claims electronically!

Advantages include:

  • Decreased submission costs (printing, handling, mailing, etc.)
  • Faster processing and reimbursement
  • Allows for documentation of timely filing
  • Data submission accuracy (eliminates keystroke errors)

EDI is for primary claims only with the exception of claims when a member’s primary insurance is ONECare and their secondary insurance is Care1st as our system automatically coordinates processing for these services submitted. Any other claims that require secondary payments submit on paper with a copy of the primary remittance advice attached.

Medical (CMS1500) Claims
We work with Emdeon for acceptance of EDI CMS 1500 claims. Our Emdeon Payer I.D. is 57116. Questions may be directed to Emdeon at 800.215.4730.

Claims may be submitted electronically directly to Emdeon or from your clearinghouse to Emdeon. If you experience problems with your EDI submission, first contact your software vendor to validate the claim submissions and upon verification of successful submission, contact Emdeon directly at 800.215.4730. If you need additional assistance contact our EDI team at AZEDI@care1st.com

Medical (UB-04) Claims
We work with SSI for acceptance of EDI UB-04 claims. Questions may be directed to SSI Help Desk at 800.880.3032. If you need additional assistance contact our EDI team at AZEDI@care1st.com.

Dental (J430D) Claims
Please refer to Dental EDI/EFT Important Details

Electronic Funds Transfer (EFT)

EFT allows payments to be electronically deposited directly into a designated bank account without the need to wait for the mail and then make a trip to the bank to deposit your check!

Medical Claims
The EFT form is available on our website under the Forms section of the Provider menu. If you do not have internet access, contact Provider Network Operations and we will provide you with the form.

Dental Claims
Please refer to Dental EDI/EFT Important Details

Paper Claims

Medical Claims Address:
Attention Claims Department
2355 E Camelback Rd #300
Phoenix, AZ 85016

Dental Claims Address:
Advantica
PO Box 8510
St. Louis, MO 63126