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.
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.
