Mercy Care Advantage (MCA) Provider Manual January 2023 Update
Applicable to: Mercy Care Advantage
Effective 1/1/2023, the MCA Provider Manual has been updated. All changes in the manual are highlighted in yellow.Detailed changes have been incorporated as follows:
Section 1.7 – Model of Care – Updated language to stress annual provider requirements.
Section 2.1 – Health Plan Authorization Services – Updated Part D Coverage Determination and Exceptions and Part D Appeal Requests note.
Section 4.32 - Health Insurance Portability and Accountability Act of 1997 (HIPAA) – Updated information regarding PCP notification of protected health information.
Section 7.0 - Dental Services Overview – Updated annual benefit allowance to $5,000 and updated coverage language.
Section 7.6 – Transportation – Updated annual allowance to 42 one-way trips or 21 roundtrips.
Section 10.3 - Pharmacy Transition of Care Process – Updated language regarding temporary transitional fill of up to a 31-day supply of a non-formulary drug, or a formulary drug requiring prior authorization at a retail pharmacy.
Section 10.5 - Part D Co-Payments – Updated information regarding cost sharing, Part D vaccines, and insulin products.
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.
