O Or within 60 days after the date of the denial of a timely claim submission, whichever is later. O Within 12 months after the date that eligibility is posted. O Within 12 months after the date of service. According to the Arizona Revised Statute, Arizona Administrative Code and AHCCCS guidelines, all claim disputes related to a claim for system covered services must be filed in writing and received by the administration or the prepaid capitated provider or program contractor:.The provider must follow all applicable laws, policies and contractual requirements when filing.The provider should contact MC Claims and/or Network Management to seek additional information prior to initiating a claim dispute.The claim dispute process should only be used after other attempts to resolve the matter have failed.A provider may file a claim dispute based on:īefore a provider initiates a claims dispute, the following needs to occur: Additionally, a Level Two report is provided to your vendor, which is the only accepted proof of timely filing for electronic claims.Ĭontact your software vendor directly for questions about your electronic billing.Ĭontact your Network Management representative for more information about electronic billing.Īll electronic submissions shall be submitted in compliance with applicable law including HIPAA regulations and Mercy Care policies and procedures.ī) Through the mail to the appropriate address:Īdditional information regarding claim submissions can be found in the Provider Manual.Ī claim dispute is a dispute involving the payment of a claim, denial of a claim, imposition of a sanction or reinsurance. Electronic billing ensures faster processing and payment of claims, eliminates the cost of sending paper claims, allows tracking of each claim sent and minimizes clerical data entry errors. Providers who are contracted with Mercy Care can use electronic billing software. To include supporting documentation, such as members’ medical records, clearly label and send to the Claims Department at the correct address. Submit original copies of claims electronically or through the mail (do NOT fax) This could result in the claim being denied for untimely filing. b) The claim form may be returned unprocessed (unaccepted) if illegible or poor quality copies are submitted or required documentation is missing.Complete ALL required fields, and include additional documentation when necessary. a) Claims must be legible and suitable for imaging and/or microfilming for permanent record retention.Instructions on how to fill out the claim forms can be found at the following AHCCCS website addresses: If you have questions regarding your claims for DentaQuest, you can contact them directly at 84. If a claim is a resubmission or a corrected claim, please send to the above address, Attention: Resubmissions.Įlectronic submission*: Through Electronic Clearing HouseĭentaQuest administers dental benefits for Mercy Care and Mercy Care Advantage. Hospital inpatient, outpatient, skilled nursing and emergency room servicesĭental services that are considered medical services (oral surgery, anesthesiology) Select the appropriate claim form (refer to table below): Non-contracted providers can refer to the AHCCCS fee schedule for reimbursement information. Refer to our Provider Manual for more detailed information.Ĭontracted providers can find reimbursement information in their Mercy Care contracts. Arizona state law and your Mercy Care provider contract prohibits balance billing MC members for Medicaid covered services and benefits. Registered providers agree to abide by state laws and agree to accept the state Medicaid payment as payment in full. Providers must register with the AHCCCS program to be eligible for payment reimbursement. Mercy Care is contracted with AHCCCS to provide Medicaid covered benefits and services to Mercy Care members. It is important to note that balance billing members is prohibited under all Mercy Care health plans.ĪHCCCS (Arizona Health Care Cost Containment System) is Arizona’s Medicaid Managed Care Program. Our updated Mercy Care Claims Processing Manual is now available to assist you with any claims or billing questions you may have.
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