PRIOR AUTHORIZATION
Referrals
Your PCP may refer you to other providers to get special services. A referral is when your
PCP sends you to a specialist for a specific problem. A referral can also be to a lab or
hospital, etc. Mercy Care may need to review and approve certain referrals and
special services first before you can go get the services. Your PCP will know when to get
Mercy Care's approval. If your referral needs to be approved by Mercy Care,
your PCP will let you know what's happening.
Authorizations
An authorization is an approval from Mercy Care for you to get the special services
your PCP has referred you to. Mercy Care may take up to 14 days to approve a routine
authorization request and 72 hours to approve an urgent request. If Mercy Care does
not receive all the necessary information to authorize the request, a 14 day extension may be
requested. If you have questions about whether your service has been authorized, call your PCP.
You do not need approval from Mercy Care to get emergency services.
You have a right to
file an appeal. For more information on how to do this click
here.