Acute Skilled Nursing Facility authorization process change effective 11/01/2019
Applicable to: Mercy Care Complete Care, Mercy Care RBHA, Mercy Care Long Term Care, Mercy Care DD and Mercy Care Advantage
Effective November 1, 2019, a process change involving acute skilled nursing facility concurrent review will be implemented by Mercy Care’s Concurrent Review department.
During business hours, Monday – Friday, the Hospital Concurrent Review Nurse (CRN) will provide a verbal authorization and approve 3 days at the skilled nursing facility. The system authorization number will be available upon admission to the SNF or shortly thereafter.
There is no change in the process for admissions to skilled nursing faciliities after business hours, including Saturday, Sunday and holidays (including New Year’s Day, MLK Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day and the following day, and Christmas Day).
A weekly review will be conducted by the CRN on day 4 of admission. Medical records must be faxed with your facility cover sheet to 1-855-773-9287 where EMR access is not provided. Mercy Care does not receive medical records, it could result in an administrative denial.
A completed Notice of Medicare Non-Coverage (NOMNC) is still required for MCA members two days prior to discharge.
Discharge summary will be requested once the member has discharged and needs to include medication list, DME, Home Health Agency, follow up appointments, and RUG scores (if MCA).
As always, don't hesitate to contact your Mercy Care Provider Relations Representative with any questions or comments. You can find this notice and all other provider notices on our Mercy Care website.