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| Electronic Claim Submission |
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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:
| Payer
Name |
Phone
Number |
MHP
Vendor Number |
Claim
Types |
|
Availity |
800-282-4548 |
43166 |
Institutional |
| |
|
MER11 |
Professional |
|
Gateway EDI |
800-556-2231 |
00365 |
Institutional |
| |
|
00360 |
Professional |
|
The SSI Group, Inc. |
800-881-2739 |
|
|
| |
|
|
|
|
Emdeon |
877-363-3666 |
43166 |
All Types |
| |
|
|
|
|
RelayHealth |
800-778-6711 |
7550 |
Institutional |
| |
|
2746 |
Professional |
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
http://www.mercyhealthplans.com/provider/.
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:
- 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.
- Submit claims in the ANSI 837
format. All Medicare required fields, as well as referral and authorization
numbers should be completed.
- Submit separate claims for
each calendar year.
- 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 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
270/271 Companion Guide |
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