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Mercy IPA Corporation Delivering Quality Managed Health Care 2525 South Michigan Avenue, Rm 2601 Chicago, IL 606162477 Change of address form H Blue Advantage HMO H HMO Illinois H Human I, confirm
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Who needs 542 - mercyipa:
01
Individuals who are eligible for Mercy Inpatient Payment Appeals (MERCYIPA) may need to fill out form 542.
02
Patients or their representatives who want to appeal a payment decision related to inpatient healthcare services may require this form.
03
Healthcare providers, such as hospitals or medical facilities, may also need to use this form when filing appeals on behalf of their patients.
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