www.mercycareplan.com                                  www.mercymaricopa.org
July 1, 2018
Provider Manual Updates - July 2018

Updates have been made to the following Mercy Care Provider Manuals effective 7/1/18:  

As indicated in each Provider Manual, all new changes are highlighted in yellow for your convenience.  In summary, changes have been made for each Provider Manual as follows:

Mercy Care Complete Provider Manual Updates
Chapter 1 - Section 1.0 - Welcome - General introduction
Chapter 1 - Section 1.1 - About Mercy Care - Information regarding merger of Mercy Care Plan and Mercy Maricopa
Chapter 1 - Section 1.3 - Mercy Care Complete Care Overview - specifics about Mercy Care Complete Care
Chapter 2 - Section 2.0 and 2.1 - Health Plan Contacts - Updated contact information
Chapter 4 - Section 4.33 - Consent Forms - updated consent forms from AHCCCS
Chapter 4 - Section 4.40 - Provider Policies and Procedures - Health Care Acquired Conditions and Abuse - The words "suicide attempts" was added.  
Chapter 8 - Section 8.3 - Prior Authorization Requirements - Updated sterilization forms added
Chapter 9 - Section 9.7 - Provider Requirements for Medically Necessary Termination of Pregnancy - Updated forms added
Chapter 10 - Section 10.5 - Emergency Dental Services for Members 21 Years of Age and Older - New benefit from AHCCCS
Chapter 11 - Non-Emergency Transportation - New chapter added regarding non-emergency transportation requirements
Chapter 12 - Section 12.1 - Referrals - new fax number added
Chapter 14 - Section 14.3 - Prior Authorization Required - Decision and Notification Standards updated based on new information received from AHCCCS
Chapter 14 - Section 14.10 - Behavioral Health Treatment of Attention Deficit Hyperactivity Disorder (ADHD), Anxiety, Depression and/or Opioid Use Disorder - Language updated based on new AHCCCS information
Chapter 14 - Section 14.13 - Discarded Physician Administered Medications - New section added based on new AHCCCS information. 
Chapter 17 - Durable Medical Equipment (DME) - Additional language added regarding DME
 
Mercy Care Long Term Care Provider Manual
Chapter 1 - Section 1.0 - Welcome - General introduction 
Chapter 1 - Section 1.1 - About Mercy Care - Information regarding merger of Mercy Care Plan and Mercy Maricopa
Chapter 1 - Section 1.3 - Mercy Care Long Term Care Overview - specifics about Mercy Care Long Term Care
Chapter 2 - Section 2.0 and 2.1 - Health Plan Contacts - Updated contact information 
Chapter 3 - Section 3.3 - Agency With Choice - Updated information regarding the provisions for Agency With Choice Providers
Chapter 5 - Section 5.33 - Consent Forms - Updated consent forms from AHCCCS
Chapter 5 - Section 5.41 - Provider Policies and Procedures - Health Care Acquired Conditions and Abuse - The words "suicide attempts" was added to this section
Chapter 9 - Section 9.3 - Prior Authorization Requirements - Updated sterilization forms
Chapter 10 - Section 10.7 - Provider Requirements for Medically Necessary Termination of Pregnancy - New forms from AHCCCS
Chapter 11 - Section 11.6 - Emergency Dental Services for Members 21 Years of Age and Older - New benefit from AHCCCS  
Chapter 12 - Non-Emergency Transportation - New chapter added regarding non-emergency transportation requirements
Chapter 15 - Section 15.3 - Prior Authorization Required - Decision and Notification Standards added per new information received from AHCCCS
Chapter 15 - Section 15.10 - Behavioral Health Treatment of Attention Deficit Hyperactivity Disorder (ADHD), Anxiety, Depression and/or Opioid Use Disorder - Language updated based on new information received from AHCCCS
Chapter 15 - Section 15.13 - Discarded Physician Administered Medications - New section added based on new information received from AHCCCS
Chapter 18 - Section 18.26 - Durable Medical Equipment (DME) - Additional language added regarding DME 
 
Mercy Care Advantage Provider Manual
Chapter 1 - Section 1.1 - About Mercy Care - Information regarding merger of Mercy Care Plan and Mercy Maricopa
Chapter 1 - Section 1.3 - Mercy Care Advantage Overview - specifics about Mercy Care Advantage
Chapter 1 - Section 1.5 - Eligibility - Updated language regarding Acute and ALTCS counties
Chapter 1 - Section 1.7 - Model of Care - Updated Model of Care Training for 2018
Chapter 2 - Section 2.0 and 2.1 - Health Plan Contacts - Updated contact information
Chapter 4 - Section 4.45 - Provider Policies and Procedures - Health Care Acquired Conditions and Abuse - The words "suicide attempts" was added to this section
 
Mercy Care RBHA 
Chapter 1 - Section 1.0 - About Mercy - Information regarding merger of Mercy Care Plan and  Mercy Maricopa, general introduction and about Mercy Care RBHA
Chapter 2 - Section 2.3 - Outreach, Engagement, Reengagement and Closure - Language updates throughout the chapter
Chapter 2 - Section 2.8 - Pharmacy Management - Language updated based on new information from AHCCCS
Chapter 3 - Section 3.0.31 - Consent Forms - Updated consent forms from AHCCCS
Chapter 3 - Section 3.0.40 - Provider Policies and Procedures - Health Care Acquired Conditions and Abuse - The words "suicide attempts" was added to this section
Chapter 4 -Section 4.0 - Covered and Non-Covered Services - The Available Behavioral Health Services table was updated. 
Chapter 4 - Section 4.1 - Maternity and Medically Necessary Pregnancy Termination - New form from AHCCCS updated
Chapter 4 - Section 4.5 - Non-Emergency Transportation - New chapter added regarding non-emergency transportation requirements
Chapter 6 - Section 6.3 - Training Requirements - Added language regarding courses being the copyrighted by Mercy Care - not to be used for profit by providers. 
Chapter 7 - Section 7.0 - Submitting Claims and Encounters to Mercy RBHA - Added additional information regarding Durable Medical Equipment
Chapter 10 - Section 10.1 - Medical Record Standards - added language that medical records must be provided free of charge to member
Chapter 11 - Section 11.2 - Coordination of Behavioral Health Care with Other Government Entities - added new information regarding Collaborative Protocol with Adult Probation
Chapter 19 - Section 19.3 - Encounter Validation Studies - New section added to manual regarding Encounter Validation Studies
Chapter 20 - Section 20.0 - Title XIX/XXI Notice and Appeal Requirement - Updated language in this section added 
 
As always, don't hesitate to contact your Mercy Care P rovider 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! 
 
 




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