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 Advantage 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 Advantage's approval. If your referral
needs to be approved by Mercy Care Advantage, your PCP will let you know what's
happening.
AUTHORIZATIONS
An authorization is an approval from Mercy Care Advantage for you to get the special
services your PCP has referred you to. Mercy Care Advantage may take up to 14 days
to approve a routine authorization request and 72 hours to approve an urgent request.
If Mercy Care Advantage 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 Advantage to get emergency services.