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Coordination of Benefits
When a member has other health insurance, whether it is Medicare, a Medicare HMO or a commercial carrier, Mercy Care will coordinate payment of benefits. These other insurers are considered the primary payer, and Mercy Care is the secondary payer.
As a secondary payer, Mercy Care will pay deductibles, co-insurance and co-payments for AHCCCS-covered services up to the lower of our fee schedule or the Medicare/other insurance allowed amount. Here are some steps to follow to help you understand how this works:
- Determine the lowest allowed amount (or fee schedule). Is it Mercy Care’s or the other carrier?
- Subtract the primary carrier’s payment from the lowest allowed amount.
- The balance due from Mercy Care is the answer to Step #2. If the difference is 0 or a negative amount, Mercy Care has no financial liability.
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Supporting Information
- Regulatory
- Medical Policies
- Facilities
4350 E. Cotton Center Blvd.,
Bldg D, Phoenix,
Arizona 85040
Member Services
7 a.m. to 6 p.m. Monday-Friday
602-263-3000,
Toll-free 1-800-624-3879
(TTY/TDD)
Toll-free: 1-866-602-1982
If you or a family member has a medical emergency, dial 911.