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Electronic Claims Submission
We are pleased to provide our participating network partners
the opportunity to submit claims electronically. E-claim submission is fast,
easy, and convenient. Some of the
clearinghouse vendors available are:
Gateway
EDI
SSI
Emdeon
To get started submitting claims electronically, please call one of the
clearinghouse vendors or contact them via their website.
As you begin the electronic claims submission process, please take some time
to review the following helpful hints, and Contact
Us
if you have any questions or comments.
- Submit the subscriber number as indicated on the Member Identification
Card.
- Member information must match the ID number, date of birth, and gender on
file with MHP.
- Submit claims in the ANSI 837 format. All Medicare required fields, as
well as referral and authorization numbers should be completed.
- Use current year procedure (CPT-4, HCPCS) and diagnosis (ICD-9) coding
only. Non-specific CPT and HCPCS codes require a description of the
service/procedure. These claims can be submitted manually with a copy of the
supporting medical record.
- Submit current diagnosis codes to the highest level of specificity (i.e.,
4th and 5th digits as required by ICD-9 coding parameters).
- Submit the beginning and ending dates of service for each procedure
including month/day/year.
- Submit separate claims for each calendar year.
- Submit actual charges.
- Use your UPIN as your provider identification number in Box 33 of the HCFA
1500.
- Submit appropriate prior authorization or referral numbers in Box 23 of
the HCFA 1500.
- Query your EDI transmittal reports daily to verify that all claims have
been accepted for processing.
Claims must be filed within 90 days of the date of service, unless the member
has other health benefits coverage as primary. If you are filing with MHP as
secondary carrier, claims should be filed manually with a copy of the primary
carrier’s EOB and within 120 days of the date of the EOB.
More information about Mercy Health Plans electronic claim submission can be
found at:
ASC X12N 835 Health
Claim Payment/Advice (004010X091) Implementation Specification
ASC X12N 837 Institutional (004010X096A1) Implementation Specification
ASC X12N 837 Professional
(004010X098A1) Implementation Specification
270/271 Companion Guide
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