Get Azccats Billing Form Instructions For Child Care Providers - Arizona ... - Azdes

The Azccats billing form is an essential document for child care providers in Arizona, used to submit claims for payment after providing services. This guide offers clear, step-by-step instructions to help users complete the form accurately for timely processing.

Follow the steps to effectively fill out the billing form.

1. Click 'Get Form' button to obtain the form and open it in the editor.
2. Begin by reviewing the computer-generated CLIENT ID at the top of the form. If you need to add a child’s ID number, write it in the non-shaded area if applicable.
3. Check the CLIENT NAME section, which is also computer-generated. If a child is missing, write their name in the non-shaded area if needed.
4. Locate the CASE MGR ID and ensure it reflects the correct child care specialist identification number.
5. Review the SERVICE DATES. If any discrepancies are found, contact the child care specialist to verify the correct dates.
6. In the SVC CODE section, confirm the computer-generated service code identifies the type of child care service provided.
7. Enter the number of units of service delivered in the UNITS AUTH/USED column. If actual units differ from the preprinted number, cross it out and write the new total.
8. Check the KIND column which indicates 'L' for less than full-day care or 'D' for full-day care. Confirm it matches the service provided.
9. Review the UNIT RATE column and ensure the reimbursement amount is accurate. Do not alter this amount.
10. Calculate the MAXIMUM AMOUNT AUTH by multiplying the units used by the unit rate. Write the resulting amount in the corresponding area.
11. If discounts apply, enter the total discount in the designated DISCOUNT column.
12. Compute the COPAY amount, which involves dividing the preprinted amount by the units authorized and entering the monthly total in the non-shaded area.
13. Calculate the TOTAL BILLED TO D.E.S. by taking the maximum amount authorized, subtracting any discounts and copay amounts, then entering the result.
14. Add up all amounts for the totals in each relevant column.
15. Sign and date the form in the PROVIDER SIGNATURE section. Double-check that the form is signed and dated to avoid return.
16. Finally, distribute the form by sending the original to the AZCCATS Payment Processing Unit and retaining a copy for five years.

Start filling out your Azccats billing form online to ensure timely payments for your services.