MedStats Billing delivers end-to-end revenue cycle management built for Arizona practices. We bill across every AHCCCS Complete Care contractor and Geographic Service Area, hold payers to both halves of the bifurcated prompt pay clock in A.R.S. § 20-3102, and price workers’ compensation to the Industrial Commission fee schedule inside the 24-month statutory bar across the Grand Canyon State.
Arizona routes Medicaid through a single state agency but three separate delivery structures. AHCCCS contracts integrated AHCCCS Complete Care plans by Geographic Service Area, layers Regional Behavioral Health Agreements on top for members with a Serious Mental Illness designation, runs long-term care through ALTCS, and pays American Indian members on a fee-for-service basis through the American Indian Health Program. Which structure applies to a given patient decides where the claim goes and which authorization rules govern it.
Arizona Billing Specializations:
AHCCCS Complete Care by Geographic Service Area — ACC contracts were reprocured for the 2024 to 2029 period. Banner–University Family Care, Care1st Health Plan Arizona, Mercy Care, UnitedHealthcare Community Plan, Molina Healthcare, Health Choice Arizona and Arizona Complete Health each carry their own claim edits and authorization standards by region.
ACC-RBHA and the SMI Designation — Members with a Serious Mental Illness designation receive integrated services through the ACC plan holding the Regional Behavioral Health Agreement for their area: Mercy Care in the Central GSA, Arizona Complete Health–Complete Care Plan in the South, and Care1st Health Plan in the North. Claims sent to the standard ACC plan instead are denied.
Arizona Prompt Pay (A.R.S. § 20-3102) — The statute sets two separate 30-day periods: 30 days from receipt to adjudicate a clean claim, then 30 days from adjudication to pay the approved portion. Unpaid claims accrue interest at the legal rate from the date payment became due. We track both clocks, not just the first.
ALTCS and AIHP Pathways — Long-term care claims run through ALTCS for elderly and physically disabled members or through the Division of Developmental Disabilities, while American Indian members enrolled in AIHP are billed fee-for-service directly to AHCCCS.
ICA Workers’ Compensation (A.R.S. § 23-1062.01) — Bills priced to the Arizona Physicians’ and Pharmaceutical Fee Schedule, submitted well inside the 24-month absolute bar, with the knowledge that a corrective billing does not restart that clock.
Major Arizona Commercial Payers — Blue Cross Blue Shield of Arizona, Banner Health Plans, UnitedHealthcare, Aetna, Cigna and Health Net denial workflows.
Built to bring clarity, control and consistency to your Arizona practice’s revenue cycle.
MedStats Billing manages the complete revenue cycle for Arizona providers — from AHCCCS registration and ACC contractor credentialing, through claim submission and denial resolution, to recovery of aged receivables and workers’ compensation underpayments.
Certified CPT, ICD-10-CM, and HCPCS coding with pre-submission claim scrubbing built around each payer's edits, so claims pay on the first pass. We manage charge entry, claim submission, payment posting, and insurance follow-up.
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Enrollment with Medicaid managed care plans, Medicare via PECOS, and commercial payers — plus CAQH maintenance and re-credentialing deadline tracking, so your providers stay in-network and billable without gaps.
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Coverage confirmed before the visit — active policy status, deductibles, co-pays, plan type, and prior authorization requirements — so front-end denials are caught while there is still time to fix them.
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Aged claims worked by payer and denial reason, with appeals filed inside each plan's window. We monitor outstanding balances, manage rejections, and drive down days in A/R to protect cash flow.
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A detailed review of coding accuracy, documentation standards, and denial patterns that identifies revenue leakage and compliance exposure — before a payer audit finds it for you.
Explore serviceLocal SEO, Google Business Profile optimization, and reputation management built for medical practices — helping the patients already searching for your specialty find you first.
Explore serviceArizona practices lose revenue to a handful of structural traps: parallel Medicaid pathways, a prompt pay statute that is widely misread, and a workers’ compensation bar that cannot be appealed once it passes. These are the four we eliminate:
Members with a Serious Mental Illness designation are served by the ACC plan holding the Regional Behavioral Health Agreement for that Geographic Service Area, not by the standard ACC plan. Claims billed to the wrong entity are denied and frequently never corrected.
A.R.S. § 20-3102 gives insurers 30 days to adjudicate and a further 30 days to pay. Practices that treat it as a single 30-day deadline chase payers too early on some claims and far too late on others, and the interest entitlement is never claimed.
Under A.R.S. § 23-1062.01 a carrier is not responsible for any bill received more than 24 months after the service was rendered, and submitting a corrected bill does not restart the period. Once it lapses the money is gone.
ACC contracts were reprocured for 2024 to 2029, and contractors changed by region. Practices still submitting under a prior contractor's edits and authorization rules see denial rates climb without an obvious cause.
A health care insurer must adjudicate a clean claim within 30 days of receipt and pay the approved portion within 30 days of adjudication, unless a provider contract sets shorter periods. We track receipt, adjudication and payment dates separately on every claim.
Claims not paid when due accrue interest at the legal rate from the payment due date. Every insurer must also operate an internal dispute resolution system under § 20-3102(F), and we use it — the Department of Insurance does not adjudicate individual claims.
Arizona splits Medicaid across ACC plans, ACC-RBHAs for SMI-designated members, ALTCS for long-term care, and AIHP fee-for-service for American Indian members. We verify the pathway before the claim is built, not after it denies.
Carriers must decide to pay or deny within 30 days and pay the approved portion within 30 days of that determination. Bills are barred entirely after 24 months. We price to the ICA fee schedule, which is RBRVS-based and updated each October.
MedStats Billing provides tailored billing solutions for a wide range of medical specialties, ensuring accurate coding, fewer denials, and faster reimbursementsto maximizes your revenue potential.
MedStats Billing handles AHCCCS registration, ACC contractor credentialing, clean claims processing, prompt-pay enforcement and Industrial Commission fee schedule appeals across Arizona, giving practices end-to-end RCM support through a Medicaid system that changes contractor by contractor and region by region.
Claims are scrubbed against ACC contractor and commercial payer edits before submission to drive clean first-pass reimbursement.
Rejected claims are audited immediately, appealed with complete clinical documentation, and tracked until they are paid.
Monthly reporting on collections, AR aging and denial trends keeps you fully informed on the health of your revenue cycle.
Working knowledge of Blue Cross Blue Shield of Arizona, Banner Health Plans, Mercy Care, Care1st, Health Choice Arizona and UnitedHealthcare submission protocols.
Whether you practice in Phoenix, Tucson, Mesa or Flagstaff, our workflows adjust seamlessly as your group grows across Geographic Service Areas.
HIPAA-compliant data handling and controlled access protect patient health information and billing records at every stage.
We integrate smoothly with widely used EHR platforms to ensure accurate data flow from documentation to claim submission. This reduces manual errors, speeds processing, and supports cleaner reimbursements.
We work alongside leading systems including:
Schedule a complimentary billing assessment with MedStats Billing to uncover hidden revenue loss, confirm your claims are routed to the correct AHCCCS pathway, and recover workers’ compensation bills still inside the 24-month window.
Under A.R.S. § 20-3102 a health care insurer has 30 days from receipt to adjudicate a clean claim, then a further 30 days from adjudication to pay the approved portion, unless the provider contract specifies shorter periods. Claims not paid when due accrue interest at the legal rate from the payment due date.
AHCCCS Complete Care plans deliver integrated physical and behavioral health services to most members. An ACC-RBHA is an ACC plan holding an additional Regional Behavioral Health Agreement, serving members with a Serious Mental Illness designation plus statewide crisis services. Mercy Care holds the Central area, Arizona Complete Health the South, and Care1st the North.
ACC contracts were reprocured for the 2024 to 2029 period. Contractors include Banner–University Family Care, Care1st Health Plan Arizona, Mercy Care, UnitedHealthcare Community Plan, Molina Healthcare, Health Choice Arizona and Arizona Complete Health, each serving specific Geographic Service Areas with their own authorization rules.
Under A.R.S. § 23-1062.01 a carrier or self-insured employer is not responsible for any bill received more than 24 months after the service was rendered, or after the provider knew or should have known it was rendered. A subsequent or corrective billing does not restart that period.
Yes. Physician assistants and nurse practitioners are reimbursed at 85% of the Industrial Commission fee schedule, except where services are provided incident to a physician’s professional services. Billing them at the full rate produces predictable reductions.
No. Arizona is an at-fault state with no personal injury protection requirement. We bill any available MedPay, coordinate with the patient’s health plan, and manage third-party liability claims so treatment is not written off while fault is determined.
We serve practices and healthcare facilities statewide across all three Geographic Service Areas, including Phoenix, Tucson, Mesa, Chandler, Gilbert, Glendale, Scottsdale, Tempe, Peoria, Yuma and Flagstaff.
