Information Regarding Utilization Management



Applicable to: Mercy Care Advantage, Mercy Care ACC RBHA, Mercy Care Long Term Care, Mercy Care DD, and Mercy Care DCS CHP

Mercy Care would like to share that Utilization Management decision-making is based only on appropriateness of care and service, and existence of coverage. The organization does not specifically reward practitioners or other individuals for issuing denials of coverage. Financial incentives for Utilization Management decision makers do not encourage decisions that result in underutilization.

For more information on Utilization Management, please review our Mercy Care Provider Manual under Chapter 100-Mercy Care General Terms, Chapter 11- Utilization (page 163). 

Please don't hesitate to contact your Mercy Care Network Management Representative or your Mercy Care Provider Educator 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!