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