Case Management

The Mercy Care Advantage Case Management staff considers the medical, social and cultural needs of members in targeting, assessing, monitoring and implementing services for members. Case managers help members and their families navigate the complex medical and behavioral health systems.

Members who are identified as "at risk," such as transplant, hemophilia and HIV members, or those who are high-service users, are assigned a case manager. All members enrolled in the Arizona Long Term Care System (ALTCS) are assigned a case manager. Additionally, members with specific conditions such as asthma, diabetes, chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) are eligible for case management.

Mercy Care Advantage also offers a multi-disciplinary program to assist providers in managing the care of pregnant members who are at risk because of medical conditions, social circumstances or non-compliant behaviors.

To refer a member to Case Management, please call (602) 263-3998 or (800) 624-3879, x3998. Referrals are assigned in three to five business days. All cases are triaged by a registered nurse.

Criteria for High Risk Case Management Referral

Please use these criteria to determine if high risk case management may be appropriate for your Mercy Care Advantage enrollee:

1. Frequent hospitalizations/ER use
2. Admissions due to inability to obtain medications/necessary referrals/DME/services in a timely manner
3. Medical Director request
4. Enrollee or enrollee’s parent needs f/u or help with DD/ALTCS referrals
5. Diagnosis of HIV, transplant or hemophilia
6. High dollar medications/equipment/services

When an enrollee refuses case management either verbally or in writing, the case is not accepted or is closed to case management. Enrollees have the right to “opt out” of the program. Due to the volume of case management referrals, we rarely open enrollees who have another primary insurance.

Case Management Referral Line: 602-586-1870
Referrals are reviewed within 3-5 business days. All cases are triaged by a registered nurse.

Do you have an enrollee in your office who needs help with housing, food or clothing? The Community Information and Referral line is an excellent resource for those in need. The phone number is 602-263-8856 or 800-352-3792, or the website address is 24-Hour Help Hotline - Community Information & Referral.