|
The Mercy Care Case Management staff considers the medical, social and cultural
needs of members in targeting, assessing, monitoring and implementing services for
members. The Case Management staff also provides assistance to members and families
in navigating through the complex medical and behavioral health systems.
Members who are identified as "at risk", such as transplant, hemophilia and HIV
members, or those who are high service users, are assigned a case manager. All members
enrolled in the Arizona Long Term Care System (ALTCS) are assigned a case manager.
Additionally, members with specific diseases such as asthma, diabetes, chronic obstructive
pulmonary disease (COPD) and congestive heart failure (CHF) are eligible for case
management.
Mercy Care also offers a multi-disciplinary program to assist providers in managing
the care of pregnant members who are at risk because of medical conditions, social
circumstances or non-compliant behaviors. They provide support and promote compliance
with prenatal appointments and prescribed medical regimens.
CRITERIA FOR CASE MANAGEMENT
Please use these criteria to determine if case management is appropriate for your
Mercy Care patient.
- Frequent hospitalizations/ER use.
- Suspected drug seeking behavior (pharmacy restriction).
- Admissions due to inability to obtain medications/necessary referrals/DME/services
in a timely manner.
- Medical director request.
- New diagnosis of CHF, diabetes, asthma or COPD.
- Patient or patient's parent needs follow up or help with DD/ALTCS referrals.
- New diagnosis of HIV, transplant or hemophilia.
- High dollar medications/equipment/services.
- A high risk pregnant member
- A patient with a history of premature birth
- A pregnant teenager
Mercy Care typically does not case manage members who are already involved in case
management with another agency in the community or who have another primary insurance.
However, if there are significant medical care coordination issues, a short-term
intervention may be considered.
Mercy Care also does not case manage patients simply because they are homeless or
"difficult" to deal with. When a patient refuses case management, either verbally
or in writing, the case is not accepted, or is closed to case management. We cannot
force patients to accept our services.
Case Management Referral Line: (602) 263-3998 or (800) 624-3879, x3998. Referrals
are assigned within 3-5 business days. All cases are triaged by a registered nurse.
COMMUNITY INFORMATION AND REFERRAL
Do you have a patient in your office that needs help with housing, food or clothing?
The Community Information and Referral line is an excellent resource for people
in need. The phone number is (602) 263-8856 or (800) 352-3792, or the Web site address
is http://www.cirs.org/.
|