1. Important Information About National Provider Identifier
2. Register For Secure Site
3. Medical Management
   1. Benefit Coverage Grid
   2. Prior Authorization
   3. Concurrent Review
   4. Case Management
   5. Dental
   6. Disease Management
4. Register for Electronic Funds Transfer
5. Member Eligibility Verification
6. Prescription Drug Information
7. Provider Manual
8. Forms
9. Coordination of Benefits
10. Skilled Nursing Facility Information
11. Network Newsletter
12. Find a Provider
13. Practice Guidelines
14. Contracting Information
15. What's New
    1. Electronic Funds Transfer

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 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.