Arizona Medical Billing Services, From Charge Entry to Final Payment
Our Phoenix billing team runs the daily claim work for Arizona practices. Charges are entered within 24–48 hours of provider sign-off, every claim is scrubbed against its payer's edits, ERAs are posted line by line, and every open balance is worked until it is paid or appealed.
Whether you run a solo clinic in Flagstaff or a multi-site group across the Valley, you can follow every claim in your own PM system and see its result in your weekly KPI report.
- HIPAA-compliant with signed BAA
- Certified coders (CPC, CCS)
- Works inside your EHR/PM
- No long-term contract
- Arizona hours, Mon–Fri 8–5 MST
- 24–48 hrsCharge entry after provider sign-off
- WeeklyKPI report for every claim
What Our Arizona Medical Billing Service Covers
Most revenue is lost in the handoffs between steps, not in any single step. We own every step from the encounter to the zero balance, so nothing falls between your front desk, your coder and the payer.
Charge entry and charge capture
We enter charges within 24–48 hours of the encounter, reconcile them against your schedule and flag missing encounters before they become lost revenue. Every CPT, HCPCS and ICD-10-CM code is checked against the documentation and the modifier logic each payer expects.
Claim scrubbing against Arizona payer edits
Before a claim leaves, it passes NCCI edits, MUEs, Noridian LCD requirements and the plan-specific rules of each AHCCCS health plan. We catch the wrong AHCCCS ID, a missing referring NPI or an expired authorization while it still costs nothing to fix.
Electronic submission and rejection management
Clean claims go out as 837P or 837I files through your clearinghouse the same business day. Clearinghouse and payer rejections are worked within one business day, because a rejected claim is not a received claim and the AHCCCS six-month filing clock keeps running.
ERA/EOB payment posting and reconciliation
We post 835 ERAs and paper EOBs line by line, match deposits to EFTs and decode every CARC and RARC. Each payment is compared with your contracted rate, so underpayments are appealed instead of written off.
Secondary and tertiary billing
Arizona has a large dual-eligible and Medicare-plus-supplement population. We cross over Medicare to AHCCCS, Medigap and commercial secondaries promptly, keeping you inside the tighter windows that many plans set for secondary claims.
A/R follow-up and denial resolution
Every open claim is worked by age and dollar value, not by alphabet. Denials are corrected, resubmitted or appealed with the documentation the specific plan wants, and every root cause is fed back to your front desk to prevent repeats.
Patient statements and balance resolution
Clear, compliant patient statements, a friendly billing phone line and online payment options reduce self-pay A/R without straining patient relationships.
Reporting you can act on
You receive a month-end report with charges, payments, adjustments, denial rate, days in A/R, net collection rate and A/R over 90 days, broken out by provider, location and payer.
RCM Solutions Built Around Arizona's Payer Mix
A national billing vendor treats Arizona as one more state on a list. We treat it as the only market we work in, which is why our claim edits mirror how Arizona payers actually adjudicate.
AHCCCS deadlines we build every workflow around.
AHCCCS treats a fee-for-service claim as timely only when the initial claim arrives within six months of the date of service. The claim then has up to 12 months from the date of service to reach clean-claim status, after which AHCCCS is not liable for payment. We track both clocks on every AHCCCS claim, so no balance ages out quietly.
We also hold Arizona plans to their own prompt-pay rules. AHCCCS contractors are expected to adjudicate the large majority of clean claims within 60 days and owe interest on late payment, and we request that interest when it is due.
| Payer group | What we manage |
|---|---|
| AHCCCS fee-for-service and AIHP | Submission through AHCCCS Online, IHS/638 tribal claims, retro-eligibility claims and replacement or void corrections |
| AHCCCS Complete Care plans | Plan-specific rules for Mercy Care, Banner University Family Care, UnitedHealthcare Community Plan, Arizona Complete Health, Health Choice Arizona and Molina Complete Care |
| ALTCS and behavioral health | Long-term care and ACC-RBHA claims, including integrated physical and behavioral health billing |
| Medicare Part B | Noridian Jurisdiction F edits, LCD medical-necessity rules, Medicare Advantage plans and crossover claims |
| Military and veterans | TRICARE West and VA Community Care Network claims through TriWest |
| Commercial | BCBSAZ, UnitedHealthcare, Aetna, Cigna and Humana, including portal follow-up and contract-rate checks |
Medical Billing for Every Size of Arizona Practice
The billing problem changes as a practice grows, so our service model changes with it.
Solo providers and small clinics
The usual problem: One biller holds everything, and vacations or turnover stall cash flow
How we run it: A full billing team behind one named account manager, at a cost below one in-house hire
Group and multi-specialty practices
The usual problem: Denial patterns hidden inside a single collections total
How we run it: Reporting by provider, location and payer, with specialty-trained billers on each queue
Multi-site groups across the Valley
The usual problem: Different payer mixes in Scottsdale, Mesa and the West Valley
How we run it: One workflow across every location, with site-level A/R and denial reports
FQHCs, rural and tribal clinics
The usual problem: AHCCCS, IHS/638 and encounter-based billing rules
How we run it: Billers trained on PPS encounter billing, AIHP and Northern Arizona's rural payer mix
Urgent care and ASCs
The usual problem: High volume, tight margins, facility and professional claims
How we run it: Same-day charge entry, UB-04 and CMS-1500 workflows and authorization checks
Hospitals and facilities
The usual problem: Backlogs, staffing gaps or aged A/R projects
How we run it: Overflow billing, legacy A/R clean-up and 837I institutional claim support
Already outsourcing and unhappy? We take over from your current billing company without a gap in submissions, and we work your inherited A/R from day one.
Specialty Medical Billing Services in Arizona
Every specialty fails claims for different reasons. Our billers are assigned by specialty, so the person working your claims already knows the edits that trip them.
Chiropractic medical billing in Arizona
AT and GA modifiers, Medicare active-treatment documentation, visit caps and personal-injury liens.
Radiology medical billing in Arizona
Professional and technical component splits, the 26 and TC modifiers, prior authorization for advanced imaging and reading-site rules.
Wound care medical billing in Arizona
Debridement depth coding, skin substitute units and wastage, and Noridian LCD frequency limits.
Mental and behavioral health
ACC-RBHA rules, AHCCCS behavioral health codes, telehealth place-of-service and time-based psychotherapy codes.
Cardiology, oncology and dermatology
Diagnostic testing, infusion and drug units, Mohs and pathology billing.
Urgent care and optometry
S-codes, facility fees, routine versus medical vision benefits.
How We Take Over Your Billing in 30 Days
Switching billing partners should not stall your cash flow. Our transition runs alongside your current process until the first payments post.
- 01
Week 1
Free billing audit
We review 90 days of claims, denials and A/R aging and show you where revenue is leaking, by payer and by code.
- 02
Week 1–2
Agreements and access
We sign a Business Associate Agreement, receive user access to your EHR/PM and clearinghouse, and confirm payer enrollments, EFT and ERA routing.
- 03
Week 2
Payer rule setup
Your fee schedule, contracted rates and payer-specific claim edits are loaded so scrubbing works from the first claim.
- 04
Week 3
Parallel go-live
We begin daily charge entry and submission while your team still has full visibility.
- 05
Week 4 onward
Legacy A/R and steady state
We work inherited A/R by filing deadline and value, and you receive your first month-end report.
We work in the systems you already use, including athenahealth, eClinicalWorks, NextGen, AdvancedMD, Kareo/Tebra, DrChrono, Epic and Office Ally. No software change is required.
Why Arizona Practices Outsource Billing to Us
In-house billing costs a salary, benefits, software, training and the revenue lost every time that biller is out. Outsourcing to us replaces that fixed cost with a team that is paid only when you are paid.
Local accountability
A Phoenix-based account manager who answers in Arizona hours and knows the plan representatives you deal with.
Payer-specific prevention
Denials are cheaper to prevent than to appeal, so our edits are written for AHCCCS plans, Noridian and BCBSAZ, not a national template.
Full transparency
You keep ownership of your data and your system access, and you see every claim we touch.
Measured results
We report clean claim rate, denial rate, days in A/R and net collection rate every month. Target figures: 98% clean claim rate, under 30 days in A/R, 95%+ net collection rate.
98%
clean claim rate target
<30
days in A/R target
95%+
net collection rate target
Pricing
Most practices pay a percentage of collected revenue, so our fee rises only when your collections rise. Flat monthly and per-claim pricing are available for high-volume or facility clients. There are no setup fees and no long-term contracts.
HIPAA compliance and data security
We sign a Business Associate Agreement before we touch protected health information. Access is role-based, all data is encrypted in transit and at rest, every user action is logged, and all staff complete annual HIPAA training.
More than billing when you need it
Medical billing is the core, and you can add related services as your practice grows:
Serving Practices Across Arizona
Our team is in Phoenix, and we bill for practices statewide, from Maricopa County groups that refer into Banner Health, HonorHealth and Mayo Clinic Arizona to Pima County clinics near Tucson Medical Center and rural providers in Northern Arizona.
We also support practices in Tempe, Peoria, Surprise, Goodyear, Prescott and Yuma.
Frequently Asked Questions
Most Arizona practices pay a percentage of monthly collections, and the rate depends on specialty, claim volume and the services included. We quote after a free audit, so the price reflects your actual workload. There are no setup fees.
Yes. We bill AHCCCS fee-for-service, AIHP and every AHCCCS Complete Care plan, including Mercy Care, Banner University Family Care, UnitedHealthcare Community Plan, Arizona Complete Health, Health Choice Arizona and Molina Complete Care, plus ALTCS.
Noridian Healthcare Solutions processes Medicare Part B claims for Arizona as the Jurisdiction F contractor. We follow Noridian's LCDs and edits and manage Medicare Advantage plans separately.
No. We work inside your current system and clearinghouse, and you keep full ownership of your data.
Claim submission speed improves in the first month. Denial rate and days in A/R usually improve within 60–90 days as root causes are fixed and legacy A/R is worked down.
Yes. Solo providers and small clinics get the same team, reporting and account manager as large groups, often at a lower cost than one in-house biller.
Yes. We run a parallel transition so submissions never stop, and we work the A/R you inherit from day one.
We sign a Business Associate Agreement, encrypt data in transit and at rest, limit access by role and train every team member on HIPAA each year.
Find Out What Your Claims Are Leaving on the Table
Send us 90 days of billing data and we will show you, payer by payer, where your Arizona practice is losing revenue and what it would take to recover it. The audit is free and there is no obligation.
Arizona Billing Services · Phoenix, AZ · Mon–Fri, 8:00 a.m.–5:00 p.m. MST · info@arizonabillingservices.com