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AFMC's Web site - An Important Tool for any Provider
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Did you know you can perform the following functions in the Provider Area on the AFMC Web site?
* Check claim re-pricing status.
* Submit a pre-cert.
* Submit a claims appeal.
* Download a copy of the AFMC Administrator Listing to assist you with eligibility and benefit questions.
In addition to the information listed above, AFMC contact numbers and fax numbers can also be found on AFMC's Web site. Please note: Your personal on-line account will deactivate if not used for 30 days and a company account if not used for 90 days. To reactivate your account, call AFMC at 602-252-4042 or 800-624-4277. |
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Do You Know What Administrators Work with AFMC?
| It's easy to find out!
Simply visit the AFMC Web site and click on the "Get Administrator Listing" under the "Provider" link or click here.
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Notifying AFMC of Provider Changes
| Providers must notify AFMC of changes in their demographic information by utilizing AFMC's Provider Change Form.
A provider may add or delete contracted physicians by notifying
AFMC in writing within 30 days of status change.
Claims for dates of service greater than 30 days prior to notification of physician status change shall be deemed as an out-of-network claim and
forwarded to the insureds payor for processing. Balance billing the insured for these claims is prohibited under your AFMC agreement.
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| Arizona Foundation for Medical Care Names Roger Stinton Executive Vice President | |
New Appointment Marks the Continuing Evolution of AFMC as a Leader in the Phoenix Healthcare Market and Beyond
The Arizona Foundation for Medical Care (AFMC) board of trustees announced on March 26 the appointment of Roger Stinton as the provider network's new executive vice president.
In this position, Stinton will be focused on continuing to grow AFMC's role as an innovative preferred provider organization working to help employer groups - in Arizona and beyond - improve healthcare access, reduce overall costs and improve health outcomes.
In addition, he will focus on new product development, improvements in contracting methods and building a solid foundation between AFMC, physicians and hospitals. Read full news release...
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| GEHA Claims Reminder | To avoid processing/payment delays for GEHA claims, please send them to the address on the back of the ID card and NOT to AFMC.
Thank you for your attention and assistance!
AFMC Claims Department |
| Situations that Require Notification to AFMC | There are several circumstances a provider must notify AFMC, in writing, within five (5) days of the occurrence of any of the following:
- License to practice medicine in Arizona is lost, restricted or suspended.
- Hospital privileges are lost, restricted or they have been suspended for a cumulative total of 30 days or more for any 12-month period.
- Any other situation arising, which might materially affect the ability to carry out duties or obligations under your agreement with AFMC.
- Professional liability insurance is canceled or reduced for any reason.
Providers must notify AFMC of changes in their demographic information by utilizing AFMC's Provider Change Form. The Provider Change Form should be used to submit a change in address, Tax ID# or specialty change, etc. A provider may add or delete contracted physicians by notifying AFMC in writing within 30 days of status change.
Questions? Contact AFMC by e-mail or calling 800-624-4277. |
| AFMC's Provider Reference Guide - A Wealth of Information at your Fingertips! | |
AFMC has created the Provider Reference Guide to assist contracted providers and their office staff in the administration of AFMC's network plans.
Whenever you have a question about any aspect of AFMC's operations as it pertains to your practice and administering of benefits to AFMC members, first check the appropriate section of the Guide. If you don't find the answer to your question, contact us. We are always willing to help.
The updated Provider Reference Guide can be accessed by clicking here or going to AFMC's Web site, click on "Provider" then "Provider Reference Guide". Please note: This is a secure area of AFMC's Web site requiring a log-in and password. Please contact us if you have any problems logging in, accessing information or need help reactivating your account.
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| Pre-Certification Review | Medical necessity is certified for all inpatient stays, either through AFMC Medical Management or a payor's designated Medical Management
Organization. Please refer to your patient's ID card for full instructions. Below are some points to remember when pre-certification is necessary:
- Determine the Patient's Plan: PPO, EPO/PPO Plus, POS, SELECT, etc. Check the patient's insurance ID card for this information.
- Be certain to use a hospital, ambulatory surgery center and other providers that participate in your patient's plan. Verify network plan enrollment status on www.azfmc.com.
It is imperative you follow these steps; there may be a penalty to the patient for out-of-network utilization. Insurance plans that use AFMC's Medical Management Services require that before a patient can be admitted to a hospital for elective procedures, the activity must be certified in advance. This is required for any scheduled elective treatment. If an elective or planned medical admission is not pre-certified, healthcare benefits may be reduced or lost. Concurrent Review
Insurance plans require that a patient's progress be monitored after admission. Nurse Coordinators work with the admitting physician, hospital and medical advisors to evaluate the patient's progress. Based on this evaluation, the number of certified days may be adjusted. In addition, Nurse Coordinators are also prepared to assist with discharge planning requirements.
Emergency Admission
In the case of an emergency or urgent admission, call AFMC or the payor's Medical Management organization within 24-48 hours of an emergency
admission. Follow the instructions listed on your patient's ID card, and refer to the AFMC Provider Reference Guide for more information.
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AFMC's Online Enrollment Verification Tool
| AFMC offers providers on-line patient enrollment verification. This information DOES NOT guarantee coverage or payment, but rather indicates that the specified patient has access to AFMC for the date of service, according to enrollment records.
To verify benefits and eligibility, you MUST contact the Administrator listed on the enrollment screen or from the patient's health plan member ID card. To access online enrollment verification log onto www.azfmc.com then:
- Click on the "provider" link, then on "enrollment search.
- Log into the secure area.
- Enter the providers TIN and PIN, then the Member's ID number or Last Name and Date of Birth. Please note, the fields are case sensitive and the date should be entered in this pattern: MM/DD/YYYY.
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