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:

  1. Determine the lowest allowed amount (or fee schedule). Is it Mercy Care’s or the other carrier?
  2. 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.