Effective 10/1/2020, Mercy Care's Provider Manual has been updated. All changes in the manual are highlighted in yellow. Detailed changes for each chapter are as follows:
All Manuals
Any reference made to "Provider Relations" has been updated to "Network Management" along with updated e-mail address.
Chapter 100 – Mercy Care Provider Manual General Terms
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Section 1.06 – Health Information Exchange (HIE) – Section added to encourage and educate our provider network to use the Health Information Exchange.
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Section 4.20 – Advance Directives – Section reworded to match our Advance Directives and End of Life Care Provider Reference Guide.
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Section 4.21 – End of Life Care - Section reworded to match our Advance Directives and End of Life Care Provider Reference Guide.
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Section 4.28 – Cultural Competency, Health Literacy and Linguistic Services – ALTA Language Proficiency Test score change altered from 9 to 10. Mercy Care RBHA requirements updated.
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Section 4.47 – Mercy Care Web Portal – The link to ProPat has been updated.
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Section 14.07 – Timely Filing of Claim Submission – This section was updated to provide latest timely filing requirements.
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Section 14.21 – MC General Claims Payment Information – A Disclosure Statement about our fee schedule was added.
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MC Chapter 16 – Workforce Development – Minor changes made throughout chapter.
Chapter 200 - Mercy Care Complete Care (MCCC) and Mercy Care DD (Mercy DD) Plan Specific Terms
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Section 2.00 – Coverage Criteria - A Disclosure Statement regarding our fee schedule was added.
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Section 3.05 – Behavioral Health Analysis – This section added to match AHCCCS AMPM 320-S regarding Behavior Analysis Services.
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Section 3.13 – General and Informed Consent - Added more detail regarding psychotropic informed consent and where to get the form on the AHCCCS website.
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MCCC Chapter 9 – Scopes of Work - Updated information added to the provider manual regarding Scopes of Work.
Chapter 300 – Mercy Care Long Term Care Plan Specific Terms
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Section 3.00 – Coverage Criteria - A Disclosure Statement was added in regard to our Fee Schedule.
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Section 4.08 - Behavioral Health Analysis - This section added to match AHCCCS AMPM 320-S regarding Behavior Analysis Services.
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Section 4.12 – Prior Authorization Requirements and Process – New section added.
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Section 4.13 – General and Informed Consent - Added more detail regarding psychotropic informed consent and where to get the form on the AHCCCS website.
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Section 5.10 – Behavioral Health Medications - Updated language to match AMPM Policy 510 and ACC.
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MCLTC Chapter 9 – Scopes of Work - Updated information added to the provider manual regarding Scopes of Work.
Chapter 400 – Mercy Care RBHA Plan Specific Terms
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Section 2.03 – Outreach, Engagement, Reengagement and Closure - Changes made under Follow-Up After Significant and/or Critical Events.
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Section 2.06 - Behavioral Health Analysis – This section added to match AHCCCS AMPM 320-S regarding Behavior Analysis Services.
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Section 2..10 - General and Informed Consent - Added more detail regarding psychotropic informed consent and where to get the form on the AHCCCS website.
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Section 2.11 – SMI Patient Navigator - Changes made regarding NTIX.
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Section 2.16 – Arizona State Hospital (AzSH) - Timely filing updated to 5 months
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Section 4.00 – Covered and Non-Covered Services - A Disclosure statement regarding our fee schedule was added.
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Section 6.10 – Behavioral Health Medications - Updated language to match AMPM Policy 510 and ACC.
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RBHA Chapter 18 - Scopes of Work – Updated information added to the provider manual regarding Scopes of Work.
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