Mercy Care RBHA's timely filing limitations are as follows: In accordance with contractual obligations, claims for services provided to a Mercy Care RBHA member must be received in a timely manner. All State Fair Hearing Requests must be sent in writing to the follow address: Please clearly state “State Fair Hearing Request” on your correspondence. The request for State Fair Hearing must be filed in writing no later than 30 days after receipt of the Notice of Decision. If a provider disagrees with the MC Notice of Decision, the provider may request a State Fair Hearing. If you are submitting via mail, the claim dispute, including all supporting documentation, should be sent to: MC may request an extension of up to 45 days, if necessary. Once received, the claim dispute will be reviewed, and a decision will be rendered within 30 days after receipt. If a provider does not receive an acknowledgement letter within five (5) business days, the provider must contact the Appeals Department. MC will acknowledge a claim dispute request within five (5) business days after receipt. Failure to specifically state the factual and legal basis may result in denial of the claim dispute. The claim dispute must specifically state the factual and legal basis for the relief requested, along with copies of any supporting documentation, such as remittance advice(s), medical records or claims. Please include all supporting documentation with the initial claim dispute submission. Written claim disputes must be submitted to the MC Appeals Department. If you choose to send via fax, please fax your disputes to 602 351-2300. Not only do we now have the ability to receive disputes by fax, but we can also respond back to our providers via fax, allowing you to receive faster decisions. You may submit your claim dispute in writing through the mail or send electronically to us through fax. O Or within 60 days after the date of the denial of a timely claim submission, whichever is later. O Within 12 months after the date that eligibility is posted. O Within 12 months after the date of service.
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