Your Primary Care Physician (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. You may also request a second opinion from another Mercy Care Plan doctor.
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 three (3) business days to approve an
urgent request. If Mercy Care Plan needs additional information to authorize the
request, a 14 day extension may be requested. If Mercy Care Plan does not receive
the information they requested from your doctor, Mercy Care Plan may deny the request.
You will receive a notice of action letter that explains your rights. If your doctor
sends in an urgent authorization request and it does not meet the criteria for an
urgent request, MCP will send you a letter and let you know that it will be processed
as a regular request. You can file a grievance if you disagree with an extension
of time. Please go to the section on Grievances for more information.
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.
Practice guidelines can be seen by clicking on the following link, http://www.guideline.gov/. These are the standards that Mercy Care providers are expected to follow when giving our members care. If you need help understanding any of these guidelines, please call Mercy Care and ask to speak to a nurse who can help you.
4350 E. Cotton Center Blvd.,
Bldg D, Phoenix,
Mercy Care Plan Member Services
7 a.m. to 6 p.m. Monday-Friday
Mercy Care Advantage Member Services
24 hours a day, 7 days a week
Select the Mercy Care Advantage option
If you or a family member has a medical emergency, dial 911.