January 30, 2018
Notice of adverse benefit determination
Mercy Maricopa Integrated Care is implementing a new process regarding Notices of Adverse Benefit Determination (NOA.)  These notices were previously known as Notices of Action.

Starting March 15, 2018, Mercy Maricopa will no longer require an NOA to be completed by a provider.  An NOA is issued for Title XIX/XXI covered services requested by persons who are Title XIX/XXI or who have been determined to have serious mental illness.

The health plan must provide the person(s) requesting services with an NOA in the following situations:
  • The denial or limited authorization of a requested service, including the type or level of service
  • The reduction, suspension, or termination of a previously authorized service
  • The denial in whole or in part, of payment for a service (this is Mercy Maricopa's responsibility)
Providers need to ensure that the member or family understands how to file an appeal or complaint.

The Appeal and Complaint process is outlined in the Mercy Maricopa Integrated Care Member Handbook.

Please refer to the Mercy Maricopa Provider Manual, Section 2.3 - Outreach, Engagement, Reengagement and Closure for requirements regarding the following areas:
  • Outreach
  • Engagement
  • Reengagement
  • No Show Policy
  • Follow-up After Significant and/or Critical Events
  • Further Treatment Declined
  • Lack of Contact
  • Administrative Factors
Training will be offered to providers regarding the change to the process.

As always, don't hesitate to contact your  Provider Relations Specialist/Consultant with any
questions or comments. You can find this notice and all other provider notices posted on our  website.
Thanks for all you do!
QB 3217