Mercy Care Advantage (MCA) Provider Manual January 2022 Update
Applicable to: Mercy Care Advantage
Effective 1/1/2022, the MCA Provider Manual has been updated. All changes in the manual are highlighted in yellow.Detailed changes have been incorporated as follows:
Section 1.3 – MCA Overview – Minor language change - added Dual to name.
Section 1.5 – Eligibility – Minor language change - adding Medicare Part C.
Section 1.6 – Annual Notice of Change – Language added regarding making a change in your benefit plan.
Chapter 3 – Network Management – Updated all language in the Provider Manual changing name from Provider Relations to Network Management.
Section 4.1 – Medicare/AHCCCS Registration – New section added in regard to ROPA.
Section 4.18 – Direct-Access Immunizations – Minor language change in this section.
Section 4.30 – Provider Marketing – Paragraph added directing provider to regulations about marketing.
Chapter 7 – MCA Covered Services and Supplemental Benefits – Most of the benefits have been positively adjusted for 2022. Highlighted changes are indicated throughout this chapter.
Section 12.0 – MCA Organization Determination Process – New paragraphs added regarding Medicare Part B Drugs.
Section 13.7 - How to File a Claim – Important new P.O. Box change indicated in this section.
Section 13.17 – Provider Payment Dispute Resolution Process for Non-Contracted Providers – Updated Appeals Department street address.
Section 13.26 – COVID-19 Compliance Guidelines – New section added to direct provider to resources concerning COVID-19.
Section 15.2 – How to File a Pard D Prescription Drug Determination (Appeal) – New IRE reconsideration request contact.
Section 16.7 – Potential Civil and Criminal Penalties – Updated entire section to reflect new information.
Section 16.9 – Exclusion Lists – Entire section updated to reflect new information.
Section 16.12 – Reporting Potential Fraud, Waste and Abuse – Updated entire section with new information.
You can access our MCA Provider Manual on our Provider Manual web page.
As always, don't hesitate to contact your Mercy Care Network Management Representative with any questions or comments. You can find this notice and all other provider notices on our Mercy Care website.
