There has been some recent confusion from providers regarding the coordination of benefits when a member has dual eligibility (coordination of benefits between Mercy Care Advantage and one of our other Medicaid lines of business). We have updated our provider manual to clarify this further. This information will be in our November 2018 edition of the Mercy Care Provider Manual:
17.09 - Dual Eligibility MCA Cost Sharing and Coordination of Benefits
Coordinating MCA Benefits with Mercy Care (with the exception of Mercy Care RBHA)
– For MCA members enrolled in both Mercy Care (either Mercy Care Complete Care, Mercy Care Long Term Care and Division of Developmental Disabilities lines of business) and MCA, any cost sharing responsibilities will be coordinated between the two payers. For the most part, providers only need to submit one claim to Mercy Care. Once the claim has been paid by Mercy Care Advantage, the claims payment information will cross over to Mercy Care and benefits will be automatically coordinated. There may be exceptions to this, which are covered in this chapter under the section titled
Instruction for Specific Claim Types
Coordinating MCA Benefits with Mercy Care RBHA
For MCA members enrolled in both Mercy Care RBHA and MCA, any cost sharing responsibilities will be coordinated between the two payers. Once the claim has been paid by Mercy Care Advantage, a remit will be sent to the provider. Mercy Care RBHA follows the CMS COBA process. Unfortunately, this may involve delays in getting the claims to cross-over to Mercy Care RBHA to coordinate benefits. To expedite claims payment, we recommend that the provider submit the MCA Explanation of Benefits, along with the claim, to Mercy Care RBHA. This will allow benefits to be coordinated quicker.
As a reminder, Mercy Care Medicaid lines of business are the payer of last resort. It’s very important to verify eligibility on all plans the member may be covered under to determine who the claim should be sent to and how the claim should coordinate.
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
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