The parties may agree to a different performance. This is called an accord. When the accord is performed, this is called an accord and satisfaction. The original obligation is discharged. In order for there to be an accord and satisfaction, there must be a bona fide dispute; an agreement to settle the dispute; and the performance of the agreement. An example would be settlement of a lawsuit for breach of contract. The parties might settle for less than the amount called for under the contract.
Dispute Claim Form For Reimbursement In Arizona
State:
Multi-State
Control #:
US-00435BG
Format:
Word;
Rich Text
Instant download
Description
Form popularity
FAQ
You have 60 calendar days from the date of BCBSAZ Health Choice's Notice of Adverse Benefit Determination or the date of any adverse action to file your Appeal. Health Choice will send you a letter stating we received your request. This will be sent to you within five working days.
Appeals must be filed with the RBHA (or AHCCCS for the TRBHAs) and must be initiated no later than 60 days after the decision or action being appealed. Appeal forms are available at AHCCCS, the T/RBHAs, case management sites and at all provider sites.
Filing an Appeal. Appeals can be filed orally or in writing within 60 days after the date of a Notice of Adverse Benefit Determination or Notice of Decision and Right to Appeal. The Notice explains to you how to file an appeal and what the deadline is for filing an appeal.
Dates of Service On or After 1/1/2021 Service TypeEDI Payor NumberPaper Claims Mailing Address Physical Health Services 68069 Ambetter from Arizona Complete Health P.O. Box 9040 Farmington, MO 63640-9040 Behavioral Health Services 68069 Ambetter from Arizona Complete Health P.O. Box 9040 Farmington, MO 63640-9040
If the member has primary insurance (i.e., insurance in addition to the Health Plan), claims or encounters must be submitted to the Health Plan within 180 days from the date of service or 120 days from the date of the primary payer's EOP, whichever one is later.
Discover AZ Complete Health. We have changed our name! Health Net Access and Cenpatico Integrated Care are now Arizona Complete Health! At Arizona Complete Health we understand that nothing is more important than taking care of you and your family.
If you are expecting a refund or owe no tax, or owe tax but are not sending a payment, mail to Arizona Department of Revenue, PO Box 52138, Phoenix, AZ 85072-2138.
Arizona Complete Health, 1850 W Rio Salado Pkwy, Ste 211, Tempe, AZ 85281, US - MapQuest.
