July 23, 2019
Enhanced Clinical Editing Processes

Applicable to: Mercy Care Complete Care, Mercy Care RBHA, Mercy Care Long Term Care, Division of Developmental Disabilities and Mercy Care Advantage
Starting in September 2019, Mercy Care will be enhancing our post-payment reviews of paid medical claims to verify the accuracy of payments.  Mercy Care is partnering with Cotiviti Corporation, a market leader in payment accuracy. 

Cotiviti is a Business Associate of Mercy Care as defined in 45 CFR, Section 160.103 of the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and will perform its responsibilities on behalf of Mercy Care in full compliance with HIPAA requirements.

As Cotiviti will be performing additional post payment reviews on behalf of Mercy Care, and consistent with this business relationship, we request your assistance in providing Cotiviti with the information necessary to complete these reviews to the same extent Mercy Care staff would be allowed.   Some of these requests may require the provision of additional information in the form of medical records.

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.  We appreciate your participation in our network and your dedication to the health and welfare of our members and your patients. 

Thanks for all you do!