Mercy Care would like to share some exciting news for our ALTCS members residing in Skilled Nursing Facilities. As of April 30, 2019, the contractual agreement between Mercy Care and OptumCare, also known as Inspiris, will terminate. To view our original provider notification in its entirety, sent on March 29, 2019, please click the link,
OptumCare Termination April 30, 2019
. While many of our members have been treated by OptumCare providers for several years, members have
always
been able to see other healthcare providers of their choice, and many have exercised that choice.
OptumCare Nurse Practitioners will no longer be providing care to Mercy Care Long Term Care and Mercy Care Advantage members in your facility under the agreement between OptumCare and Mercy Care. However, it is possible that the Member’s current practitioner is contracted with Mercy Care under a different group and may continue to provide services for that Member.
OptumCare and Mercy Care have enjoyed a strong partnership for years and are committed to ensuring as smooth a transition as possible for our members, their family and your facility's staff. We understand that you may have questions around this change and we have prepared the following Q&A to assist you.
1. Does OptumCare go by any other name?
Yes, OptumCare is also known as Inspiris.
2. Who does the SNF call with member care and referral questions?
You should always contact the
m
ember’s assigned Case Manager for any questions and/or concerns about the
m
ember’s care or referrals.
3. How do I find out who my Case Manager is?
The Case Manager is identified in the member’s chart/record at the SNF as well as on the authorization in the Mercy Care Secure Portal.
4. Why is the relationship with Mercy Care and OptumCare changing?
Mercy Care and OptumCare have had a long-standing relationship for many years. The two organizations have made changes to their business model and operational strategy, resulting in the mutual decision to terminate the existing contract between the two entities.
5. Will the
m
embers be able to keep their existing NP?
Mercy Care will be paneling to a participating provider; however, if the member is seeing a non-par NP, PCP or specialist while in the SNF setting, Mercy Care will continue to pay those services on a non-par basis without interruption to services provided.
6. Are
m
embers able to change their assigned PCP?
Yes,
m
embers are able to change their assigned PCP to
any other PCP that is
contracted under Mercy Care.
7. How do I change my PCP?
Members can work with their Case Manager to select a new PCP, or call Member Services at 602-263-3000 or toll-free at 1-800-624-3000 (TTY/TDD 711) for assistance in selecting a PCP.
8. The Optum NP at our facility is giving members a notice from Optum and telling the member if they (the NP) can continue caring for the member if the member switches to OptumCare's D-SNP plan.
In many cases, Mercy Care has been able to keep the member with the same physician of record. Additionally, Mercy Care has worked with many of our contracted SNFs to assist Mercy Care in assigning members to the groups and NPs that already have an established presence/relationship in the facility.
9. What other provider groups is Mercy Care contracted with that provide services in the Skilled Nursing Facilities?
Mercy Care is currently contracted with the following provider groups to provide care and treatment to members residing in a Skilled Nursing Facility.
- Team Health (includes: Arizona Post Acute Medical Services, Hospitalists of Arizona, IPC, Arizona Post-Acute Services)
- Pop Health of Arizona, PC, LLC
- Scottsdale Physicians Group
- Leading Healthcare, PLLC
- Integrated Premier Group
- Unomed, LLC
10. What are the responsibilities of the Primary Care Provider (PCP)?
PCPs are responsible for the following:
- Providing initial and primary care services to assigned members, including: rendering, or ensuring the provision of, covered preventive and primary care services to the member. These services will include, at a minimum, the treatment of routing illness, maternity services if applicable, immunizations, Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services for eligible members under age 21, adult health screening services and medically necessary treatments for conditions identified in an EPSDT or adult screening.
- Initiating, supervising, and coordinating referrals for specialty care and inpatient services and maintaining continuity of member care.
- Maintaining the member’s medical record.
**For a more detailed list of PCP responsibilities, please visit our Provider Manual, Chapter 100, General Terms, Section 4.13- Primary Care Responsibilities.
11. If a member is assigned to a new PCP, does that mean that they can no longer see anyone else?
No. Members can continue to see both contracted and non-contracted providers in the SNF setting.
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!
