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Effective 3/9/2023, the Mercy Care Claims Processing Manual has been updated. All changes in the manual are highlighted in yellow.
Detailed changes are listed below:
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Section 1.3 – Electronic Tools and Mercy Care Web Portal - This section was updated to reflect that for ERA and EFT, Change Health will now be processing these changes effective March 31, 2023.
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Section 1.8 – Timely Filing - Specific instruction given when MC is secondary payor. This now matches what is in the Provider Manual.
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Section 1.10 – Resubmission Process - Language correction made that resubmission attachments are able to be addressed electronically. Also added the Claims Resubmission address.
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Section 1.18 – Date Spans - Updated language to reflect the recent Provider Notification sent regarding Date Spans and the AHCCCS notification regarding date span billing for Provider Types 77 and IC.
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Section 2.0 – Laboratory Services - Updated language to indicate the same rules apply to Non-Title XIX/XXI plan. Also additional codes to our Mercy Care in-office list.
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Section 2.1 – Influenza and Vaccine Guidelines – Updated links.
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Section 2.16 – HEDIS Measures - Updated manual language to match what we have on our HEDIS web page.
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Section 2.18 - Chiropractic Claims - Chiropractic information added regarding claims processing.
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Section 2.20 – Continuous Glucose Monitor - Updated codes new codes.
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Section 2.22 – Augmentative and Alternative Communication Device Systems (AAC) - This section was added to provide further detail regarding AAC.
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Section 3.1 – Well Child Visits - Added chart to reflect the Prevention and Wellness Chart.
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Section 3.5 – Eye Glass Coverage - This section was added per the request of AHCCCS and a provider notification that was sent on 3/17/22.
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Section 6.7 – Share of Cost – Clarified Share of Cost language.
You can access the Mercy Care Provider Claims Processing Manual on our Claims web page for all lines of business by clicking on the link.
As always, don't hesitate to contact your Mercy Care Network Management Representative with any questions or comments. You can find this Notice and all other provider notices on our Mercy Care website.
Thanks for all you do!
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