August 1, 2019

´╗┐Court Ordered Evaluation (COE) Project Deployment

SPSI would like to remind our clients who perform COE services that the new process for handling court-ordered evaluation and pre-petition screening claims for Mercy Care RBHA begins today. There are several important technical points to note regarding the submission of these claims:

  • COE services cannot be combined with non-COE services in the same claim.
  • COE modifier/condition code must be used on all claims as seen below:
  • Professional: Modifier '32' is expected on the CPT/HCPCS code related to COE services and may occur in any position
  • Institutional: Condition code 04 is expected (Loop2300, HI101, 'BG^04')

SPSI will separate claims with these modifiers or condition codes to send to a separate portal at Mercy Care for adjudication. The modifier and condition codes will be sent to Mercy as received (they will NOT be stripped from the claim). It is not necessary to send COE claims in a separate 837 file to SPSI.

Mercy will return a hybrid 277 claim status response file with adjudication information that SPSI will make available to our clients.
Thank you for your attention to this important notice. Please contact Mercy Care or SPSI for additional information regarding this change.

Southwestern Provider Services, Inc. (SPSI)
SPSI Arizona  | 1400 E. Southern Ave., Suite 925, Tempe, AZ 85282 | 480.534.5713