June 25, 2019
Billing appropriate rates for Home and Community Based Services

Applicable to: Mercy Care Long Term Care and Division of Developmental Disabilities

As a reminder, it's important to note that Home and Community Based providers should bill their services at the appropriate contract rates in order to avoid receiving payment less than their contract rate. This happens when a provider bills less than their contracted rate. 

According to the "lesser of language" in your contract, providers are paid for covered services provided to members under the terms of the provider agreement, those fees set forth in the applicable Mercy Care Fee Schedule at the lower of the provider's billed charges, or the fee amounts set forth in the Mercy Care Fee Schedule . The Mercy Care fee schedule may change from time to time. 

We have noted that several providers are billing less than their contracted rate, thereby shortchanging themselves. While we cannot adjust the claims we have identified, we are sending this notification to educate you in order to avoid this in the future. Our Provider Relations team will be working with you to further educate. 

As always, don't hesitate to contact your Mercy Care Provider Relations 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!