Electronic Claim Submission

We appreciate your interest in submitting claims electronically. History shows that billing electronically can reduce claim processing time by 60%. Electronic claim submission is fast, easy, and convenient!

To get started submitting claims electronically, please contact one of the clearinghouse vendors listed below for more information:

Help us process your claims quicker! 

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.

Tips for better service:

• Use our secure site, Provider Connection, to check claim status and eligibility/benefit information on-line, 24 hours/ 7days at provider.mercyhealthplans.com.
• Submit the subscriber number as indicated on the Member Identification Card.  (ex. M12345678) 
• Verify the accuracy of the member information (i.e. ID number, date of birth, and gender), to ensure MHP can match against their system.
• Submit appropriate prior authorization or referral numbers in Box 23 of the CMS-1500 (08 05).
• Query your EDI transmittal reports daily to verify that all claims have been accepted for processing.
• File claims 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.
• Submit your group/billing NPI in Box 33a of the CMS-1500 (08 05). 
• Submit your individual/rendering NPI in Box 24J of the CMS-1500 (08 05).
• Submit your tax identification number in Box 33b of the CMS-1500 (08 05).

Standard billing procedures for claim submissions:

1. Submission of rendering provider, group NPI, and the federal employer identification number (FEIN) are required. Use of secondary identifiers continues to be acceptable. For additional information on NPIs and many other useful topics, visit our website at http://www.mercyhealthplans.com/provider/NPI_learn_more.aspx.
2. Submit claims in the ANSI 837 format. All Medicare required fields, as well as referral and authorization numbers should be completed.
3. Submit separate claims for each calendar year.
4. 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.
5. Submit current diagnosis codes to the highest level of specificity (i.e., 4th and 5th digits as required by ICD-9 coding parameters).
6. Submit the beginning and ending dates of service for each procedure including month/day/year.
7. Submit actual charges. 

ASC X12N 835 Health Claim Payment/Advice (004010X091) Implementation Specification

ASC X12N 837 Institutional (004010X096A1) Implementation Specification

ASC X12N 837 Professional (004010X098A1) Implementation Specification