Claims information

Mercy Care and Mercy Care Advantage provide detailed claims processing information for you though the Claims Processing Manual.  

It is important to note that balance billing members is prohibited under all Mercy Care health plans.

Under Mercy Care Advantage (MCA)

Mercy Care Advantage (HMO SNP) is a Medicare Advantage Dual Eligible Special Needs Plan, contracted with the Centers for Medicare and Medicaid Services (CMS) to provide services to individuals eligible for Medicare and Medicaid (AHCCCS) coverage. Federal law prohibits balance billing of dually eligible individuals enrolled in the Qualified Medicare Beneficiary (QMB) Program. QMB is a Medicare Savings Program that exempts Medicare beneficiaries from Medicare cost-sharing liability.  Medicare participating providers may not balance bill QMB individuals for Medicare cost-sharing, regardless of whether the State reimburses providers for the full Medicare cost-sharing amounts. Medicare participating providers - not only those that accept Medicaid - must refrain from charging QMB individuals for Medicare cost-sharing. MCA contracted providers must accept the MCA Medicare payment and the Medicaid plan payment (if any) as payment in full for Medicare covered services and benefits.

Refer to our Provider Manual for more detailed information.

Medical and professional services

CMS 1500 Form


Hospital inpatient, outpatient, skilled nursing and emergency room services

CMS UB-04 Form 


General dental services

ADA 2012 Claim Form 


Dental services that are considered medical services (oral surgery, anesthesiology)

CMS 1500 Form

 

Claims Mailing Address:

Medical

Mercy Care Claims Department 
P. O. Box 982975
El Paso, TX  79998-2975

If a claim is a resubmission or a corrected claim, please send to the above address, Attention:  Resubmissions.  

Electronic submission*: Through Electronic Clearing House


Dental Claims Address:  

For All Lines of Business: 

DentaQuest of Arizona, LLC
Attention: Claims Department
P. O. Box 2906
Milwaukee, WI 53201-2906 

 

Electronic submission*: Through Electronic Clearing House


Refunds

Mercy Care Finance
P.O. Box 90640
Phoenix, AZ 85066

Electronic submission*: N/A

Instructions on how to fill out the claim forms can be found at the following AHCCCS website addresses:

Complete the claim form.

  1. a) Claims must be legible and suitable for imaging and/or microfilming for permanent record retention. Complete ALL required fields, and include additional documentation when necessary.
  2. b) The claim form may be returned unprocessed (unaccepted) if illegible or poor quality copies are submitted or required documentation is missing. This could result in the claim being denied for untimely filing.

Submit original copies of claims electronically or through the mail (do NOT fax)

To include supporting documentation, such as members’ medical records, clearly label and send to the Claims Department at the correct address.

a) Electronic Clearing House

Providers who are contracted with Mercy Care can use electronic billing software. Electronic billing ensures faster processing and payment of claims, eliminates the cost of sending paper claims, allows tracking of each claim sent and minimizes clerical data entry errors. Additionally, a Level Two report is provided to your vendor, which is the only accepted proof of timely filing for electronic claims.

The EDI vendors that we use are:

  • Change Healthcare
  • SPSI
  • SSI

Contact your software vendor directly for questions about your electronic billing.

Contact your Provider Relations representative for more information about electronic billing.

All electronic submissions shall be submitted in compliance with applicable law including HIPAA regulations and Mercy Care policies and procedures.

b) Through the mail to the appropriate address:

Additional information regarding claim submissions can be found in the Provider Manual.