Claims

Per your contract, we need to receive claims for services you provide our members in a timely manner: 

• New claims: File claims with a valid claim form within 150 days from the date you performed services or from the date of eligibility posting, whichever is later. Do this unless there is a contractual exception. For hospital inpatient claims, date of service means the date of patient’s discharge.

• Claim resubmissions: File claim resubmissions within 365 days from the date you performed services or eligibility posting deadline, whichever is later. Exception: If a claim is recouped, you have another 60 days from the recoupment date to resubmit a claim. Be sure to include any documentation that may affect the outcome or decision.

If you don’t submit claims in a timely manner, this may result in a denial for timely filing.   

EFT is electronic funds transfer, directly to your bank account. Setting up EFT:

• Improves payment consistency
• Allows for fast, accurate and secure transaction

ERA is an electronic file that contains claim payment and remittance info. Setting up ERA:

• Reduces manual posting of claim payment info, which saves you time and money, while improving efficiency 
• Removes the need for paper Explanation of Benefits (EOB) statements

EERS offers payees multiple ways to set up EFT and ERA in order to receive transactions from multiple payers. If a provider’s tax identification number (TIN) is active in multiple states, a single registration will auto-enroll the payee for multiple payers. You can also complete registration using a national provider identifier (NPI) for payment across multiple accounts.  

How does it work?

ECHO Health processes and distributes Mercy Care claims payments to providers. To enroll in EERS, visit the ECHO portal. You can manage electronic funds transfer (EFT) and electronic remittance advice (ERA) enrollments with multiple payers on a single platform.

Sign up for EFT

To sign up for EFT, you’ll need to provide an ECHO payment draft number and payment amount for security reasons as part of the enrollment authentication. Find the ECHO draft number on all provider Explanation of Provider Payments (EPP), typically above your first claim on the EPP. Haven’t received a payment from ECHO before? You’ll receive a paper check with a draft number you can use to register after receiving your first payment.

Update your payment or ERA distribution preferences

You can update your preferences on the dedicated ECHO portal.

Use our portal to avoid fees

Fees apply when you choose to enroll in ECHO’s ACH all payer program. Be sure to use the ECHO portal for no-fee processing. You can confirm you’re on our portal when you see “Aetna Better Health” at the top left of the page.

Be aware — you may see a 48-hour delay between the time you receive a payment, and an ERA is available.

Questions?

You can contact ECHO via email or by phone at 1-888-834-3511. Or contact your Network Management representative.

Additional ECHO resources

ECHO Portal Guide

ECHO Frequently Asked Questions

ECHO EFT/ERA Companion Document Supplemental Guide

Was your claim overpaid or paid in error? You can contact us for help by calling Claims Investigation Claims Research at 602-263-3000.

Send any refunds to:

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

All disputes related to a claim for system-covered services must be filed in writing and received by the administration or the prepaid capitated provider or program contractor within one of these time frames:

• Within 12 months after the date of service

• Within 12 months after the date that eligibility is posted

• Within 60 days after the date of the denial of a timely claim submission, whichever is later

These time frames are according to the Arizona Revised Statute, Arizona Administrative Code and AHCCCS guidelines.
 

Mercy Care Advantage providers

Contracted providers with Mercy Care Advantage do not have claim dispute rights. You must submit claims you’re disputing through the resubmission process. 

Federal regulations prohibit us from handling your complaints under the Medicare Advantage appeals process. This is because you are a contracted provider with Mercy Care Advantage.

You can submit your claims dispute by:
 

Fax (preferred method)

We can receive and respond to your dispute by fax, allowing you to get faster decisions: 860-907-3511.

Email

Mail

Mercy Care Grievance and Appeals 
4750 S. 44th Place, Ste. 150
Phoenix, AZ 85040

Be sure to include all supporting documentation with the initial claim dispute submission. The claims dispute must:

• Specifically state the factual and legal basis for the relief requested

• Include copies of any supporting documentation, such as remittance advice(s), medical records or claims

Failure to specifically state the factual and legal basis may result in denial of the claim dispute.

1. We’ll acknowledge a claim dispute request within 5 business days after receipt. If you don’t receive an acknowledgement letter within 5 business days, resend your fax. 

2. Once received, we’ll review the claim dispute and make a decision within 30 days after receipt. We may ask for an extension of up to 45 days, if necessary.   

3. If you disagree with our Notice of Decision, you can ask for a State Fair Hearing. You must file the request for a State Fair Hearing in writing no later than 30 days after receipt of the Notice of Decision. Please mark your correspondence “State Fair Hearing Request.” Send it to: 

   Mercy Care Grievances and Appeals
   Attention: Hearing Coordinator 
   4750 S. 44th Place, Ste. 150
   Phoenix, AZ 85040 

For more information about coordination of benefits, go to your provider manual.

Payer IDs 

Mercy Care ACC-RBHA with SMI 
CMS 1500 and UB-04: 33628 

All other Mercy Care plans  

• CMS 1500: MCP1 

• UB-04: MCPU

Change Healthcare

Phone: 1-877-363-3666, option 1 for Sales 

Payer IDs 
Mercy Care ACC-RBHA with SMI
CMS 1500 and UB-04: 33628 

All other Mercy Care plans
CMS 1500 and UB-04: 86052

Relay Health  

Phone: 1-866-RELAY-ME (1-866-735-2963), ext. 2

Payer IDs 
Mercy Care ACC-RBHA with SMI 
CMS 1500 and UB-04: 33628 

All other Mercy Care plans 
CMS 1500 and UB-04: 86052 

All electronic submissions comply with applicable laws, including HIPAA regulations and Mercy Care policies and procedures.

Questions about electronic billing? Contact us or your EDI vendor for answers. 

January 2025