Arizona

To calculate an Arizona Medicaid claim at 100% of the state regulation rates, use the default settings. All fields are required.

Note: Refer to the contract to determine the options to select and the values to enter.

The following table describes the fields on the AZ tab of the Medicaid - Facility reimbursement tool.

Field

Description

Override Provider Number

Preferred provider number. Up to ten alphanumeric digits.

Override Service Date

Preferred service date. Use MM/DD/YYYY format. Overrides the service date on the claim with the date you enter. You may use the anchor date instead of this option.

State Code

This field defaults to AZ, and it cannot be changed.

Do not consume charges

Provides the option not to consume charges. This is used for contract carve outs.

Do not consume units

Provides the option not to consume units. This is used for contract carve outs.

Percent Reimbursement

Three digit percentage amount.