“The Families First Coronavirus Response Act requires private health plans (including insured, self-insured, and grandfathered, as defined in section 1251(e) of the Patient Protection and Affordable Care Act)) and government programs (including Medicare and Medicaid) to provide coverage for COVID-19 diagnostic testing and related services free of charge (without cost-sharing, such as deductibles, copayments, and coinsurance) to the public, through the end of the national COVID-19 emergency period.

 Covered services and related cost waivers apply to diagnostic testing, healthcare provider services (in-person and telehealth), and facility costs (physician office, urgent care center, and emergency room) to the extent the costs are related to the evaluation and diagnosis of COVID-19. Prior authorization or other medical management requirements for such services do not apply through the end of the national COVID-19 emergency period. If the visit does not result in a COVID-19 test, or provides services unrelated to COVID-19 testing, cost-sharing and plan limitations may apply. The Families First Coronavirus Response Act does not require group health plans or insurers to cover treatment for complications related to COVID-19. If testing finds COVID-19 to be present, treatment of the complications will likely be subject to normal cost-sharing and network requirements.”

 

What is the name of this company?

We are Mercy Benefit Administrators, formerly known as St. John’s Claims Administration.

Are we considered an in-network or participating provider for this patient?

Please visit the Mercy Provider Directory to find out, or call us at 1-877-875-7700.

What is the address of Mercy Benefit Administrators?

The claims mailing address is:
Mercy Benefit Administrators
P.O. Box 14230
Springfield, MO 65814

What is your Electronic Payer ID number?

Our Electronic Payer ID for traditional TPA clients is 37264.

Our Electronic Payer ID for re-pricing clients is 43185.

Where can I verify benefits?

Please note that verification of benefits is not a guarantee of payment. Please contact us, or call us at 1-877-875-7700.

Where can I verify a patient’s eligibility?

To check eligibility of a member: click here.

For a guide to self-registering on the provider portal: click here.

 

Please note that eligibility is not a guarantee of benefits.

Where can I check to see if pre-certification or pre-authorization is required?

If your patient belongs to any Group Health Plan administered by Mercy Benefit Administrators, pre-authorization or pre-certification is required for the following:

  • Click here for a copy of the list.
  • Please note: this is not an all-inclusive list. If you still need assistance to determine if your procedure requires pre-authorization or pre-certification, please please contact us at 1-877-875-7700.

How do I obtain a pre-certification or pre-authorization for the patient?

If your patient belongs to the Hermann Area Hospital District Group Health Plan, please call 844-841-3891.

If your patient belongs to any other Group Health Plan administered by Mercy Benefit Administrators, please call 800-330-8305.

Where can I check the status of a claim?

To check the status of a claim: click here.

For a guide to self-registering on the provider portal: click here.