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About Prior Authorization
Mercy Care Plan requires prior authorization for selected acute outpatient services and planned hospital admissions. Prior authorization is not required for emergency services.
To request prior authorization electronically, visit MercyOneSource.
- How to Request a Prior Authorization
- Timeframes for Processing Requests
- Mercy Care Plan's Covered Benefits
- Check the Status of a Prior Authorization
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: (800) 217-9345 (Toll Free) |
Fax: 602-431-7363 (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.
Forms
- Prior Authorization Request Form
- Durable Medical Equipment, Orthotics and Prosthetics Prior Authorization Request Form
- Therapy and Home Health Prior Authorization Form
- Pharmacy Prior Authorization
- Schaller Anderson Family Planning Prior Authorization Form
- GYN Prior Authorization Form
- OB Prior Authorization Form
-
Supporting Information
- Contractor Survey Results
4350 E. Cotton Center Blvd.,
Bldg D, Phoenix,
Arizona 85040
Member Services
7 a.m. to 6 p.m. Monday-Friday
602-263-3000,
Toll-free 1-800-624-3879
(TTY/TDD)
Toll-free: 1-866-602-1982
If you or a family member has a medical emergency, dial 911.