Mercy Care: The Inside Scoop

March 12, 2025

Our Secure Provider Portal - Availity

Did you know our secure provider portal (Availity) offers training via webinars, recorded training, and training demos? Click Read More to learn about topics available and how to access/register for training.

New Prior Authorization Requirements

CLICK HERE for new CPT Codes requiring Prior Authorization effective 3.5.2025 - Excludes Mercy Care Advantage.

Transportation: Pick Up and Drop Off

Reminder: When submitting claims for transportation services, please ensure that the pickup and drop-off addresses are accurately represented. To submit the necessary pick-up and drop-off location on the claims, the billing requirements vary depending on whether the claims are submitted via EDI or on paper.

NEMT Provider Travel vs. Loaded Transportation

For NEMT, there are two different billing scenarios:

Loaded transportation (the member is with the staff)
Provider travel (the provider is traveling to where the member is to provide a service)

Updates From AHCCCS & the Department of Child Safety

Clozapine REMS Program Update

Effective February 24, the FDA issued a statement effectively ending the requirements of the Clozapine Risk Evaluation and Mitigation Strategies (REMS) Program. The FDA statement is as follows: February 24, 2025 - Beginning today, FDA does not expect prescribers, pharmacies, and patients to participate in the risk evaluation and mitigation strategies (REMS) program for clozapine or to report results of absolute neutrophil count (ANC) blood tests before pharmacies dispense clozapine.

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After hours consents

The Department of Child Safety would like to provide you with information when you require after-hours consents for admissions, medications, treatment or transfers.

All previous directives regarding implied consent are no longer valid or enforceable as of February 26, 2025.

Claims & Billing Updates

Payment of Total Obstetrics Care Package

Mercy Care will reimburse Obstetrics services on a fee for services basis, unless specifically contracted in a different manner. Billing should be in accordance with Current Procedural Terminology (CPT®) rules.

Family Planning Claims

Family planning services are funded and contracted through Aetna Medicaid Family Planning for Mercy Care. Click Read More to learn more about services covered for Family Planning.