Care1st Health Plan Arizona

Filing a claim

Please be sure to verify eligibility prior to submitting a claim. Utilize the member ID card to submit the accurate member name, date of birth and ID number.

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 submission is available for all claims (including those with primary insurance coverage). Note: When a member’s primary insurance is WellCare Liberty (FKA ONECare) 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. For these secondary exceptions a secondary red and white paper claim is required with a copy of the primary remittance advised attached

Medical records can be submitted electronically via secure FTP. Please contact our EDI team at AZEDI@care1stAZ.com to set this up.

Exception during the Covid-19 emergency: In addition to the Secure FTP option above, medical records with 50 pages or less may also be submitted electronically in the following format:

  • SECURE email to SM_AZ_ClaimsDataEntry@Care1st AZ.com
    • Subject line: Care1st Claim Number (Example: 001234567)
    • Body of email: Provider Tax Id, Member ID, Date of Service
    • Attachment: medical records

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

Claims may be submitted electronically directly to Change Healthcare or from your clearinghouse to Change Healthcare. 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 Change Healthcare directly at 800.215.4730. If you need additional assistance contact our EDI team at AZEDI@care1stAZ.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@care1stAZ.com.

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 Network Management and we will provide you with the form.

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 Address:
Attention Claims Department
P.O. Box 31224
Tampa, FL 33631-3224

Note: The address above is for claims only (including claims with attachments). All other non-claim correspondence should be sent to the following address:
Attention Correspondence Department
1870 W Rio Salado
Tempe, AZ 85281

Dental Claims Address:

Claims for dates of Service on or before September 30, 2019
Advantica
PO Box 8510
St. Louis, MO 63126

Claims for Date of Service on or after October 1, 2019
DentaQuest of Arizona, LLC - Claims
PO Box 2906
Milwaukee, WI 53201-2906

Claims Disputes:
Claim disputes must be submitted in writing to the address below.
All requests for dispute should include a complete Claim Dispute Form or a letter detailing the factual and legal basis for the disputes.
Attention Dispute Department
1870 W Rio Salado
Tempe, AZ 85281