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Prior Authorization
Prior authorization typically takes two forms. Your doctor will work with you to determine if you need referral to a specialist or an authorization for special services
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 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's approval. If your referral needs to be approved by Mercy Care, 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.
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Last Updated 12/20/2011