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  • Resubmission Form - The Mercy Healthcare Group

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4350 E. Cotton Center Boulevard Building D Phoenix, AZ 85040 (602) 263 -3000 (800) 624-3879. RESUBMISSION FORM. Please complete this form .

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XX7 is submitting a replacement/corrected claim. XX8 if submitting a void/cancel of a previous claim. The original claim number should be submitted in field 64 of the paper claim. If at all possible, include the original claim number on the form.

Keep in mind, there is typically a time-frame in which a claim can be resubmitted ie. 30 days from receiving the initial denied claim.

A resubmission occurs when you cannot obtain an authorization for a cardholder-initiated purchase. A resubmission is valid only when the original authorization was declined for insufficient funds and only for a limited number of days after the original purchase.

Payer Name: Mercy Care Plan (AHCCCS)|Payer ID: 86052|Professional (CMS1500)/Institutional (UB04)[Hospitals]

How you resend an insurance claim is dependent on whether it was rejected or denied. There are two fundamentally different methods: Resubmission (when a claim has been rejected) Corrected Claim (when a claim has been denied)

A "Resubmission" is defined as a claim originally denied because of missing documentation, incorrect coding, etc., which is now being resubmitted with the required information.

Mercy Care RBHA's timely filing limitations are as follows: New claim submissions: Claims must be filed on a valid claim form within 150 days from the date services were performed or from the date of eligibility posting, whichever is later, unless there is a contractual exception.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232