Mercy Care Plan and Mercy Maricopa Integrated Care has developed the technology to look across claim types during claims adjudication. This will allow us to correctly adjudicate claims where conflicts may exist between professional (CMS-1500) claims and institutional (CMS-1450) claims.
For example:
A procedure is reported by a physician in a place of service indicating a physician's office while the same procedure is also reported by an ambulatory surgical center on a facility claim. This conflict would be identified so that the provider receives the appropriate reimbursement.
A home infusion service is reported from a member indicating the service took place in a patient's home on a CMS-1500 but a CMS-1450 claim indicates that the member was an inpatient during that period of time. This conflict would be identified so that the home infusion provider receives appropriate reimbursement.
Implementing this new payment policy capability to evaluate services across claim types will enable both Mercy Care Plan and Mercy Maricopa Integrated Care to more accurately and appropriately adjudicate services.
with any questions or comments. You can find this notice and all other provider notices posted on the Mercy Maricopa
website. You can find information about how to reach your Mercy Care Plan Provider Relations Representative on the
MCP website and provider notices on the
provider notifications page.
