|
Mercy Care Plan/Mercy Care Advantage/Mercy Healthcare Group requires prior authorization
for selected acute outpatient services and planned hospital admissions. Prior authorization
is not required for emergency services. Questions about covered services, the status
of a referral or the need for authorization should be directed to the Prior Authorization
Department.
REQUESTING A PRIOR AUTHORIZATION
1. ALWAYS verify Member eligibility prior to the provision of services.
2. Complete appropriate referral/authorization form (OB/GYN, Medical or Pharmacy)
and attach supporting documentation.
3. Submit request via FAX, Web site or telephone.
FAX
Outpatient Requests &
Elective Surgeries
|
Inpatient Hospital
|
Pharmacy
|
Fax: (602) 659-1655 (Phoenix)
(800) 217-9345 (Toll Free)
|
Fax: (602) 659-1963
(866) 300-3926 (Toll Free)
|
Fax: (800) 854-7614 (Toll Free)
|
WEB SITE
Some authorizations may be requested via the secure Web Portals at www.MercyCarePlan.com,
www.MercyCareAdvantage.com and www.MercyHealthcareGroup.com.
Providers will need to register and obtain a password in order to access the secured
Web Portal. Call your Provider Services representative if you need assistance with
registering.
TIMEFRAMES FOR PROCESSING REQUESTS
Urgent - An urgent request is appropriate for a non-life threatening condition,
which if not treated promptly, will result in a worsened or more complicated patient
condition. An urgent request will be responded to within up to 3 working days upon
receipt of request.
We encourage you to call the Prior Authorization Department for all urgent requests.
Routine - A routine request is a non-urgent request that will be responded
to within 14 calendar days upon receipt of request.
FORMS - CLICK HERE
PRIOR AUTHORIZATION REQUIREMENTS - CLICK
HERE
NEW TELEPHONE AND WEB PA SUBMISSION PROCESS - CLICK
HERE
Beginning in Pima County April 23, 2007. Process will expand to other counties throughout
the next several months.
|