March 13, 2019
Acute Skilled Nursing Facility authorization process change

Applicable to: Mercy Care Complete Care, Mercy Care RBHA, Mercy Care Long Term Care, Division of Developmental Disabilities and Mercy Care Advantage
Effective March 15, 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. The system authorization number will be available upon admission to the SNF or shortly thereafter. 
  • After business hours, including Saturday, Sunday and holidays (including New Year’s Day, MLK day, Memorial Day, Independence day, Labor day, Thanksgiving and the following day, and Christmas day), no immediate authorization will be provided. If a member has a skilled need and a facility accepts the member, a request may be submitted to Mercy Care for review by the clinical team on the next business day. It is the responsibility of the discharging hospital and the accepting SNF to ensure the member meets medical criteria to ensure reimbursement.  
  • A concurrent review of the member’s medical records must be completed by a CRN, in order to approve the member’s skilled stay and generate a system authorization. Records must be faxed by the next business day and include the following information:  
  • Facility face sheet
  • Physician orders
  • Progress notes
  • Therapy evaluation notes with prior level of function
  • History and Physical
            Please fax these documents along with your facility cover sheet to 1-855-773-9287 .       
            If Mercy Care does not receive all the above documents by the next business day,
           it could result in an administrative denial. 
  • A weekly review will be conducted by the CRN after receipt of the initial documentation.   Requests for subsequent reviews will be faxed 3 days before the next weekly review date for facilities where EMR access is not available. If records are not received on the due date, a second request will be issued by the CRN, with potential denial if records are not received. 
  • 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 .

Thanks for all you do!