Claims Information

The Mercy Care RBHA Claims department is responsible for claims adjudication, resubmissions, claims inquiry/research and provider encounter submissions.  

Contracted providers can find reimbursement information in their Mercy Care contracts. Non-contracted providers can refer to the AHCCCS fee schedule for reimbursement information.

Mercy Care RBHA Claims Department

P.O. Box 64835 Phoenix, AZ

85082-4835

 

Mercy Care RBHA (Dental)

P.O. Box 62978 Phoenix, AZ 

85082-2978

Call our Claims Inquiry/Claims Research department at 1-800-564-5465 (toll-free), hearing impaired (TDD/TTY) 711

Electronic Claims Submission (EDI)

Electronic Fund Transfer (EFT)

Electronic Remit (ERA)

  • Change Healthcare
  • SPSI
  • Relay Health

 

For additional information regarding your electronic tools, call your Provider Relations representative at 1-800-564-5465 (TDD/TTY) 711.

 

Vendor: Southwestern Provider Services (SPSI)

Payor ID: 33628

Contact information:

www.spsi-edi.com

1-817-684-8500


Vendor: Change Healthcare

Payor ID: 33628

Contact information:

www.changehealthcare.com/

1-877-363-3666, Option 1 for Sales


Vendor: Relay Health

Payor ID: 33628

Contact information:

www.relayhealth.com/ 

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

Mercy Care RBHA is the payer of last resort.  If a member has other insurance, that insurance would be primary. We would require a copy of their explanation of benefits. Per our contract, we follow “lesser of” language when we coordinate benefits.

In accordance with contractual obligations, claims for services provided to a Mercy Care RBHA member must be received in a timely manner. Mercy Care RBHA's timely filing limitations are as follows:

  • New claim submissions: Claims must be filed on a valid claim form within 180 days (six months) from the date services were performed or from the date of eligibility posting, whichever is later, unless there is a contractual exception. For hospital inpatient claims, date of service means the date of discharge of the patient.
  • Claim resubmission: Claim resubmissions must be filed within 365 days (one year) from the date of provision of the covered service or eligibility posting deadline, whichever is later. The only exception is, if a claim is recouped, the provider is given an additional 60 days from the recoupment date to resubmit a claim. Please submit any additional documentation that may effectuate a different outcome or decision.

Failure to submit claims in a timely manner could result in your claim being denied for timely filing.  

Additional information regarding claims is available in our Provider Manual.