Applicable to: Mercy Care Complete Care, Mercy Care Long Term Care, Mercy Care RBHA, Mercy Care DD, and Mercy Care Advantage
Mercy Care is happy to announce our On-Line Prior Authorization Search Tool (ProPat) is now available on our website with no log-in. It has been moved from our Secure Web Portal to our Prior Authorization tab/webpage for each line of business. Locations are as follows:
ProPat gives you the ability to look up codes to determine if they require Prior Authorization.
The tool is the same for all lines of business, however, it's important to note that you must indicate the line of business you are searching for in the tool to make sure accurate information is pulled for that line of business.
Mercy Care requires prior authorization for select acute outpatient services and planned hospital admissions. Prior authorization is not required for emergency services. To request a prior authorization, be sure to:
Always verify member eligibility prior to providing services.
Complete the appropriate authorization form (medical or pharmacy).
Attach supporting documentation when submitting. This could include:
Recent progress notes documenting the need for the service
Lab results
Imaging results (x-rays, etc.)
Procedure/Surgery reports
Notes showing previous treatment tried and failed
Specialty notes
To check on the status of an authorization, please visit our Mercy Care Web Portal (MCCC, MCLTC, MCDD and MCA) or our Mercy Care RBHA Web Portal (Mercy RBHA). For more information about prior authorization, please review Mercy Care's Provider Manuals located under the Provider Information tab on our website.
You can fax your authorization request to 1-800-217-9345.
Important to Note: When checking whether a service requires an authorization under Mercy Care’s Online Prior Authorization Search Tool , please keep in mind that a listed service does not guarantee that the service is covered under the plan’s benefits. Always check plan benefits first to determine whether the service is covered or not.
