Claims overview. Submitting clean claims and encounters . Claim Submission Tips. Provide complete member information: Member ‘s Name Member’s Date of Birth Member’s ID Number Member’s Address
It’s always important to verify that the information provided by the member matches the member’s ID card. Watch for name variations and changes. It is also important to verify eligibility prior to services being rendered, unless an urgent/emergent situation. Problems with member information could cause an unnecessary delay or possible claim denial.
Claims must be filed on a valid claim form within 180 days (6 months) from the date services were performed, unless there is a contractual exception. Exceptions to this are as follows:
Resubmissions must be filed within 365 days (1 year) from the date of provision of covered services 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.
If other insurance is primary, you must submit the claim within 180 days to preserve your appeal rights. Submit the other insurance EOB along with the claim submission as soon as received from the primary insurance.
Mercy Maricopa Integrated CareMercy Maricopa Advantage
Until 4/1/2014 - contact Magellan at: 602-586-1843
(phone number to be updated) TTY/TDD 711
For Health Plan Assistance: CVS Caremark:
Phone: 602-586-1880 Phone: 855-582-2023
Provider Relations: Website:
Phone: 602-586-1880 www.mercymaricopa.org
E-Mail: Mercy Maricopa Provider Relations@Aetna.com
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