New Form - Prior Authorization - Clinical Trial Form
Applicable to: Mercy Care Complete Care, Mercy Care DD, and Mercy Care ACC-RBHA, Mercy Care Long Term Care and Mercy Care DCS-CHP
Mercy Care has recently added a new prior authorization request form for Clinical Trials. The new form is called Prior Authorization for Clinical Trial and can be found on the Mercy Care website by viewing our Forms web page. This form will be utilized going forward as a request for prior authorization for participation in Clinical Trials, which our providers will send us in addition to the requested clinical information for the member.
If you have any questions, please reach out to your Provider Representative. You may find this Notice and all other notices on our Provider Notices web page.
