June 7, 2019
Prior Authorization for Residential Substance Abuse for adults

Applicable to: Mercy Care Complete Care and Mercy Care RBHA

All admissions and continued stays at Behavioral Health Residential Facilities (BHRF) (Provider Type B8) for Mercy Care members will require prior authorization in accordance with the AHCCCS Medical Policy Manual (AMPM) 320-V - Behavioral Health Residential Facilities. Mercy Care is implementing the following process for authorization for BHRFs that PRIMARILY provide substance use residential treatment services to members.

Starting May 15, 2019 Mercy Care will start to accept requests for prior authorization. Claims will continue to be paid without prior authorization until June 15, 2019 (benefit, frequency and non-covered service limitations will still apply). Starting June 15, 2019, a prior authorization will be required for these services and service rendered without authorization may be denied for payment. 

All new admissions starting May 15, 2019 will require notification of admission within 24 hours of admission, along with appropriate clinical assessment. This information must be faxed to 844- 424-3976.  Please submit the new form, Prior Authorization: GMH/SU Residential Substance Use , available under the forms section of our website.

Contracted providers are required to continue to submit the existing weekly spreadsheet to Systems of Care and update the ASAM clinical assessment every 30 days. 

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!