www.MercyCareAZ.org

July 8, 2022

Mercy Care Provider Manual July 2022 Update



Applicable to: Mercy Care Complete Care, Mercy Care RBHA, Mercy Care Long Term Care, Mercy Care DCS CHP, and Mercy Care DD

                           

Effective 7/6/2022, the Mercy Care Provider Manual has been updated. All changes in the manual are highlighted in yellow.


Detailed changes for each chapter are listed below:


Chapter 100 – Mercy Care Provider Manual General Terms

  • Section 4.06 – Verifying Member Eligibility - Added this section to align with ACOM 416 for Provider Manual requirements. 
  • Section 5.01 – Requirements for EPSDT Providers – This section was revised to clarify Clinical Sample Templates Attachment E from AHCCCS.     
  • Section 5.10 – Eye Examinations and Prescription Lenses - Added language regarding eyeglass coverage for EPSDT per AHCCCS. A Provider Notification sent on 3/17/2022. 
  • Section 14.12 – Correct Coding Initiative - Updated ClaimCheck to ClaimsXten. 
  • Section 15.00 – Fraud and Abuse Overview - Updated phone number from AHCCCS to report FWA in Maricopa County.  


Chapter 200 - Mercy Care Complete Care (MCCC), Department of Child Safety Comprehensive Health Plan (DCS CHP) and Mercy Care DD (Mercy DD) Plan Specific Terms

  • Section 2.01 – Covered Services - Updated per AHCCCS eyeglasses and replacement change. 
  • Section 3.04 – Case Management Caseload Ratio Guidelines - Updated language.  
  • Section 3.22 – Assessments - Changed timing from 30 days to 72 hours per AAC R9-10-1011
  • Section 3.23 – Minimum Elements of the Behavioral Health Assessment - Language change.  
  • Section 4.02 – Referral and Intake Process - Language change. 
  • Section 4.03 – Outreach, Engagement, Reengagement and Closure - CMDP Youth reengagement language added. 
  • Section 9.00 - Provider Requirements for Specific Programs and Services - Integrated Rapid Response for Children document updated.  



Chapter 300 – Mercy Care Long Term Care Plan Specific Terms

  • Section 3.01 – Covered Services - Updated per AHCCCS' recent update regarding eyeglasses and replacement. 



Chapter 400 – Mercy Care RBHA Plan Specific Terms

  • Section 1.02 – Overview of Mercy RBHA - Correction made to language.   
  • RBHA Chapter 2 – Network Provider Service Delivery Requirements - Changed SMI Clinic to RBHA Health Home. 
  • Section 3.04 – Case Management Caseload Ratio Guidelines - Language change made.  
  • Section 4.00 – Covered and Non-Covered Services - Updated per AHCCCS change on replacement of eyeglasses. 
  • Section 8.00 – Dental Overview - Updated Dental section to reflect that RBHA is transitioning to DentaQuest effective 7/1/2022.
  • Section 8.01 – Dental Covered Services - Updated Dental section to reflect that RBHA is transitioning to DentaQuest effective 7/1/2022.
  • Section 9.00 – Provider Requirements for Specific Programs and Services – Integrated Rapid Response for Children document updated. 


You can access the Mercy Care Provider Manual on our Provider Manual web page for all lines of business by clicking on the link. 


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.


Thanks for all you do!


                           
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