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.
Our updated Mercy Care Claims Processing Manual is now available to assist you with any claims or billing questions you may have.
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Where do I mail my claims?
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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
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Who do I call if I have a claims question?
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Call our Claims Inquiry/Claims Research department at 800-564-5465 (toll-free), hearing impaired (TDD/TTY) 711
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What type of electronic capabilities does Mercy Care RBHA have?
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Electronic Claims Submission (EDI)
Electronic Fund Transfer (EFT)
Electronic Remit (ERA)
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Who are Mercy Care RBHA's electronic claim submission vendors?
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- 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)
CMS 1500 and UB-04 Payer ID - 33628
Contact information:
817-684-8500
Vendor: Change Healthcare
CMS 1500 and UB-04 Payer ID - 33628
Contact information:
877-363-3666, Option 1 for Sales
Vendor: Relay Health
CMS 1500 and UB-04 Payer ID - 33628
Contact information:
866-RELAY-ME (866-735-2963 ext. 2)
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How does coordination of benefits work?
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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.
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Do you have timely filing submission rules?
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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 on our Provider Manual web page.