(928) 779-2113
Claims FAQ
The information below pertains to general claims processing guidelines. Please visit Claims Helpful Hints for updated information on specific claims processing topics. Claims Helpful Hints is updated regularly to outline claims processing tips and update providers on our electronic claims, EFT and ERA processing improvements.
- How do I submit claims to Capstone Health Plan?
- How long do I have to submit a claim to Capstone Health Plan?
- How soon can I expect payment on a claim sent to Capstone Health Plan?
- What should I do if I have questions on a claim?
- Why must Capstone Health Plan recoup a claim paid in error rather than request a refund?
- What is the appeal process for claims?
How do I submit claims to Capstone Health Plan?
Capstone Health Plan currently accepts CMS1500 claims electronically through Emdeon Business Services Customer Solutions. Please contact Emdeon at (800) 845-6592 for information regarding electronic claims submission to Capstone.
Paper claims should be mailed to:
Capstone Health Plan, Inc.
914 N San Francisco St Ste A
Flagstaff, AZ 86001
How long do I have to submit a claim to Capstone Health Plan?
Per AHCCCS guidelines, providers have 6 months from the end date of service to file an initial claim and up to 12 months to resubmit a clean claim. Claims not submitted within these timeframes may be denied for timely submission. These timely filing requirements apply even if Capstone Health Plan is not the primary insurer. Therefore we require that providers submit an initial claim within 6 months even if an EOB has not been received from the other insurer. This submission will allow the provider the additional time in which to submit a clean claim with and EOB.
How soon can I expect payment on a claim sent to Capstone Health Plan?
Capstone Health Plan processes all claims for payment within a maximum of a 30 day timeframe. Electronic claims submission typically results in faster claims processing times. Claims check runs are bi-monthly with a mid month and end of month cycle. We ask that providers wait at least two weeks before inquiring about a claims status or resubmitting a duplicate claim.
What should I do if I have questions on a claim?
For questions on claims please email claims@nazcap.com or call the Claims Department. Claims Specialists are available Monday thru Friday, 8:00am to 5:00pm to answer your questions.
Why must Capstone Health Plan recoup a claim paid in error rather than request a refund?
All claims paid by Capstone Health Plan are required to be submitted electronically (encountered) with AHCCCS. Claims paid incorrectly will fail.
What is the appeal process for claims?
If you feel that an error has been made in your payment, you should contact Capstone Health Plan at claims@nazcap.com or call 1-928-779-2113 or 1-800-336-3874.
The claims appeal process is outlined on the provider remittance advice. For a sample remittance advice, follow the link.
