January 18, 2019
Integrated Denial Notices for Organizational Determination requests

Applicable to: Mercy Care Advantage
Effective January 1, 2019 Mercy Care Advantage will no longer be issuing Integrated Denial
Notices (IDN) for services that are not a covered benefit under Mercy Care Advantage, but
covered under Mercy Care. The Organizational Determination process is as follows:
  • If the request is classified by the plan as a fully covered benefit under the plan’s Medicaid benefits the Medicare IDN will not be sent to the enrollee or the provider.
  • If there is uncertainty whether or not the requested service(s) are covered by Medicare, then the plan will send a determination which may include a Medicare IDN.
  • The change that goes into effect 1/1/19 is for enrollees who are dually enrolled with Mercy Care Advantage and Mercy Care. This new change has also been made to our provider manuals.

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!