9.1.                                Claims Submission

The electronic submission of claims to MHP is the single most important action providers may take to ensure accurate and timely payment of claims. MHP encourages all providers to submit claims electronically. 

Participating EDI Vendors

Below is a list of Electronic Data Interchange (EDI) vendors that participate with MHP. Their website address and toll-free numbers are included, as well as the MHP payor ID for each vendor. If you require assistance to set up electronic billing in your office, please contact your provider relations field representative.

Please see the MHP website at mercyhealthplans.com for our latest 835 companion guide.

EDI Billing Guidelines

• When submitting claims electronically, EDI acceptance of electronic files is enhanced by submitting:

• The patient’s member identification number and name as it appears on their MHP ID card, as well as the patient’s date of birth and group account number;

• Current diagnoses (ICD-9) codes to the highest level of specificity as well as current year procedure codes (CPT, HCPCS) including modifiers where applicable;

• Supporting documentation with non-specific CPT and HCPCS codes (these claims may be submitted manually with a copy of supporting medical records);

• Complete dates of service including beginning and end dates;

• Separate claims for each calendar year;

• Rendering (type 1) and billing (type 2) NPIs (if applicable) with tax identification number (TIN);

• Appropriate prior authorization numbers as required;

• Claims in the ANSI 837 format with all Medicare required fields including modifiers; and

• Claims within MHP’s timely filing limit.

Paper Billing Forms

Paper billing forms may be utilized by MHP providers. Please consult your participation agreement for any specific requirements. 

Please mail all claims to:

Mercy Health Plans
P.O. Box 4568
Springfield MO 65808-4568