Effective 11/30/2018, Mercy Care's Provider Manual has been updated with the following changes:
Chapter 100 – Mercy Care Provider – General Terms
- Section 4.11 – Emergency Services – Updated language to include services that should not be performed in the Emergency Room.
- Section 4.39 – Duty to Report Abuse, Neglect or Exploitation – Updated language to reflect that this applies to all lines of business.
- Section 4.40 – Duty to Warn – Updated language to reflect hat this applies to all lines of business.
- Section 4.44 – Provider Directory – Updated language to reflect hat this applies to all lines of business.
- Section 9.01 – Covered Services – Clarifying language regarding medical necessity was added to this section.
- Section 10.01 – Assessments – Updated language that was missed when updating our 10/1/2018 Provider Manual. This was requested by Emily Chapman-Hushek.
- Section 10.04 - Update to Assessment and Service Plan - Updated language that was missed when updating our 10/1/2018 Provider Manual.
- Section 11.00 - Care Management and Disease Management Overview – Listed out Clinical Guidelines and clarified where to find them on our website.
- Section 16.07 – Prior Authorization – Added additional language regarding our reduced prior authorization requirements.
- Section 16.09 – Medical Prior Authorization - Added additional language regarding our reduced prior authorization requirements.
- Section 17.09 - Dual Eligibility MCA Cost Sharing and Coordination of Benefits – The language in this section was revised based on regulatory input regarding the coordination of benefits between our different lines of business.
- Chapter 19 – This entire chapter was newly created based on new AHCCCS Workforce Development requirements.
Chapter 200 – Mercy Care Complete Care Provider Manual – Plan Specific Terms
- Section 2.01 – Covered Services – Added occupational therapy as a covered service.
- Section 5.01 – Dental Covered Services – Updates made to language regarding dental covered benefits.
- Section 6.01 – Provider Claim Disputes – Fax number change.
Chapter 300 – Mercy Care Long Term Care Provider Manual – Plan Specific Terms
- Section 3.01 – Covered Services - Added occupational therapy as a covered service.
- Section 5.00 – Dental Services - Updates made to language regarding dental covered benefits.
- Section 6.01 – Provider Claim Disputes – Fax number change.
Chapter 400 – Mercy Care RBHA Provider Manual – Plan Specific Terms
- Section 4.00 – Covered and Non-Covered Services - Added occupational therapy as a covered service.
- Section 6.00 – Dental Services - Updates made to language regarding dental covered benefits.
- Section 14.00 – Enrollment, Disenrollment and Other Data Submission – Language updated.
You will be able to 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!
