PRIOR AUTHORIZATION

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 Mercy Care Plan 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 72 Hours 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

CLICK HERE to view outpatient prior authorization changes.

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.



Pending CMS Approval
H5580_09_298