Remittance Advice information illustrating how claims were paid, pended, denied or voided are available electronically or on paper. Both the electronic and paper remittance advices are generated weekly after each check run cycle.
ASC X12N 835 submitters
Providers that submit X12/837I or 837P will receive an 835 payment advice file in accordance with National Electronic Data Interchange Transaction Sets.
Transaction name: ASC X12N 835 (004010X091A)
Description: Claim Payment and Remittance Advice
- If the provider is a direct submitter, 835’s will be posted to their assigned secured drop location (SFTP). If the providers submit claims/encounters through a Clearinghouse, the Clearinghouse will supply the provider with their remittance advice through their data exchange process. The Clearinghouse upon registration with Cenpatico will be supplied the secured location to obtain the ASC X12N 835. Options for retrieval are;
- Assigned SFTP drop zone. This is established after the Trading Partner Agreement and Electronic Remittance Authorization documents have been signed and returned to Cenpatico’s Claims Technical Assistance Department.
- Cenpatico’s Provider Portal
- Payment History link (Direct key)
- Batch link (X12 submitters)
- Providers that have an account with PaySpan can retrieve their remittance responses from PaySpan secured web portal at www.payspanhealth.com
Web Portal Submitters
Providers that have access to Cenpatico’s Provider Portal, that use the Direct Key option under the Create Claim link can retrieve their remittance advice under the Payment History link.
Paper Remittance Advice
Paper Remittance Advice are generated weekly and mailed to the billing provider. If the billing provider has submitted claims for multiple service providers, the Remittance Advice will contain a section for each. If a provider has not received their RA or need a historical copy, contact Cenpatico’s Claims Technical Support Team at CAZClaims@cenpatico.com or by phone at 1-866-495-6738.
For more information or further clarification on the RA process, please contact Cenpatico’s Claims Technical Support Team at CAZClaims@cenpatico.com or at 1-866-495-6738 (Claim TA Dept).
As a provider is setting up to submit and received files electronically, there will be the absence of a paper remit. Cenpatico would like to convey appeal information at this time. Please save for future references. If a provider cannot resolve a dispute informally through the claims department at 1-866-495-6738, the provider claims dispute process affords behavioral health providers the opportunity to challenge a decision by the RBHA that impacts the provider. Behavioral health providers may dispute issues involving:
- A payment of a claim
- The denial of a claim
The claim dispute for a denial of a claim for payment must be filed within the following established time frames:
- 12 months of the date of delivery of service; or
- 12 months after the date of eligibility posting; or
- Within 60 days after the denial of a timely claim submission, whichever is later
A formal request for a re-evaluation of a denial or a payment may be made in writing and sent to the attention of the Appeals Coordinator:
333 E Wetmore Rd
Tucson, AZ 85705
Please state any pertinent information as clearly as possible. Please give names, date, etc., and any extenuating circumstances which would allow Cenpatico integrated Care to make an informed decision. Medical records must be included with the appeal, when appropriate. Please attach a copy of the EOP if possible. In order for Cenpatico Integrated Care to consider the appeal it must be received within 60 days of the date on the EOP which contains the denial of payment that is being appealed, unless otherwise state in your contract.
In accordance with Arizona Administrative Codes (AAC) R9-28-702 a contractor or subcontractor, or other provider of care or services shall not charge, submit a claim, demand or otherwise collect payment from a member or eligible person, or person acting on behalf of the member, for any covered service except to collect an authorized co-payment or payment for additional services. This means that a Cenpatico Integrated Care member may not be billed for a covered service.