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 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 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.