Claims and Payment

We utilize best practices to ensure timely and accurate payment to our network providers.

Claims can be submitted using one of the following options:

Electronic Claims

Claims can be submitted using one of the following options:

Verify member eligibility
Check & submit claims
Submit & confirm authorizations
View detailed patient list

Electronic claims can be submitted to clearinghouses:

Care1st EDI Payor Number is 68069
EDI submission is available for all claims (including those with primary insurance coverage).

Note: When a member’s primary insurance is WellCare by Allwell and their secondary insurance is Care1st, our system automatically coordinates processing for these services and no secondary submission is required for all services other than Home Health Care, Durable Medical Equipment, MSIC/IC, or FQHC/RHC services.

Paper Claims

Paper claims are mailed to the address below and must be submitted on a red and white claim form with the claim sorted as the first page of the document.

Medical Claims (CMS1500 and UB-04)
- Care1st Health Plan Arizona
  Attention: Claims Department
  PO Box 8070
  Farmington, MO 63640-8070
Dental Claims
- Envolve Dental Claims
  PO Box 21588
  Tampa, FL 33622-1588

Payment

PaySpan - EFT/ERA

Care1st partners with PaySpan Health to provide an innovative web-based solution for Electronic Funds Transfers (EFTs) and Electronic Remittance Advices (ERAs). This service is provided at no cost to providers and allows online enrollment.

Corrected Claims Submissions

Clean claim resubmissions 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.

To resubmit a corrected EDI claim, the Claim Frequency code (3rd character in the bill type) in the 2300 loop CLM05-3 segment should be populated with a '7' to indicate replacement of previous claim. The original Care1st Health Plan Arizona generated claim ID, if known, should be sent in the 2300 CLM loop with a REF segment with an F8 qualifier.

To resubmit on paper, corrected claims must be appropriately marked as such.

For a UB04, the 3rd digit of the bill type in Box 4 should indicate a '7' as a replacement of previous claim. The Care1st Health Plan Arizona generated claim ID in Box 65 labeled Payer Claim ID.
For CMS1500 submission, the claim resubmission code in Box 22a should contain a '7' for replacement of previous of claim and the original Care1st Health Plan Arizona generated claim ID should be sent in Box 22b labeled the Original Ref number.