June 24, 2019
Provider Manual June 2019 Update

Applicable to: Mercy Care Complete Care, Mercy Care RBHA, Mercy Care Long Term Care, and Division of Developmental Disabilities

Effective 6/20/2019, Mercy Care's Provider Manual has been updated with the below changes: 

Links from the Table of Contents to each chapter, as well as section, have been added for your convenience.  

Detailed changes to each chapter are as follows: 

Chapter 100 – Mercy Care Provider – General Terms:
  • Section 13.03 – Prior Authorization Required – Language request change on the last bullet regarding certain medications requiring prior authorization.  
  • Section 14.02 – Quality of Care, Peer Review and Fair Hearing Process – Language request change regarding QOC Severity Levels. 
  • Section 14.04 – Ambulatory Medical Record Review (AMRR) – Entire section has been updated with current process. 
  • Section 15.01 – Incorporating Peer and Family Voice and Choice in Integrated Care Service Delivery – Language change request regarding Advisory Council. 
  • Section 17.08 – MC as Secondary Insurer – Updated language to reflect new timely filing requirements from 180 days to 150 days. A previous provider notification was sent regarding this. 
  • MC Chapter 19 – Workforce Development – Changes made throughout the chapter to document most recently changes to Workforce Development. 

Chapter 200 – Mercy Care Complete Care – Plan Specific Terms:
  • Section 4.03 – Outreach, Engagement, Reengagement and Closure – Reengagement for GMH/SU members and Reengagement of Children members was updated. 

Chapter 300 – Mercy Care Long Term Care – Plan Specific Terms – no changes made at this time. 

Chapter 400 – Mercy Care RBHA – Plan Specific Terms
  • Section 1.02 – Overview of Mercy RBHA – Language regarding Data Collection Instrument added.   
  • Section 2.03 – Outreach, Engagement, Reengagement and Closure - Reengagement language regarding Children members was updated.   
  • Section 2.04 – Assessment and Service Planning – Language added regarding ART meetings. 
  • Section 2.07 – SMI Patient Navigator – Language addition regarding connective level of care. 
  • Section 3.06 – Provider Financial Reporting - Available Financial Reporting documents added to language. 
  • Section 16.00 – Title XIX/XXI Notice and Appeal Requirements – Language added regarding Complex Case Request and ACT Services. 

You can access our Provider Manual on our Provider Manual web page.  All changes to the Provider Manual are highlighted in yellow.

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!