Mercy care rbha provider manual

Mercy Care Provider Manual October 2022 Update

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

Effective 10/1/2022, 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:

All chapters have been updated to include the updated contract name AHCCCS Complete Care - Regional Behavioral Health Agreement (ACC-RBHA) in stead of Regional Behavioral Health Authority (RBHA). These changes are not highlighted in yellow as there are so many of them.

Chapter 100 – Mercy Care Provider Manual General Terms

Section 1.01 – About Mercy Care – Changed the description of RBHA to ACC-RBHA.
Section 2.00 – Mercy Care Contact Information – This section was revised to include our provider customer service (CICR) phone number.
Section 4.02 - Appointment Availability Standards - Updated language to clarify standards.
Section 4.03 - Telephone Accessibility Standards - Updated language to clarify standards.
Section 4.06 - Verifying Member Eligibility - Language revised regarding payment if the member is not assigned to their primary care physician, unless covering for them.
Section 4.21 – End of Life Care - Added Advance Directives and End of Life Provider Reference Guide.
Section 14.24 - Skilled Nursing Facilities (SNFs) - Updated Share of Cost (SOC) language based on new information received from our regulator for DD members.
Section 15.00 - Fraud and Abuse Overview - A new phone number has been added per the request of AHCCCS.
MC CHAPTER 16 – WORKFORCE DEVELOPMENT - Updated language changes highlighted in yellow for clarity.

Chapter 200 – MCCC, Mercy DD and DCS CHP – Plan Specific Provider Manual

Section 3.28 – Housing for Individuals Determined to have Serious Mental Illness (SMI) for Central GSA – Language updates have been made regarding SMI members.
Section 5.11 - Request for Non-PDL Drugs – Language change regarding AHCCCS Fee-For-Service Prior Authorization criteria.
Section 6.00 – Peer and Family Support Services and Peer and Family Run Organizations – Updated language changes made.
Section 7.00 - Dental Overview - Corrected DentaQuest address.
Section 8.00 - Grievances - Updated language changed made.

Chapter 300 – Mercy Care Long Term Care – Plan Specific Provider Manual

Section 4.26 – Housing for Individuals Determined to have Serious Mental Illness (SMI) for Central GSA – Language changes have been made regarding SMI members.
Section 5.11 - Request for Non-PDL Drugs – Language change made regarding AHCCCS Fee-For-Service Prior Authorization criteria.
Section 6.00 – Peer and Family Support Services and Peer and Family Run Organizations – Language changes made.
Section 7.00 - Dental Overview - Corrected DentaQuest address.

Chapter 400 – Mercy Care RBHA – Plan Specific Provider Manual

Section 1.00 – About Mercy Care ACC-RBHA - Updates language regarding ACC-RBHA and counties affected.
Section 2.04 – Outreach, Engagement, Reengagement and Closure - One year changed to six months.
Section 2.06 – Crisis Intervention Services - Added Crisis/State Only Membership Reference Guide.
Section 2.09 – Clinical Guidelines - Language changes added.
Section 2.10 – Serious Mental Illness Decertification – Language c hanges added.
Section 2.13 – Pre-Petition Screening, Court Ordered Evaluation, and Court Ordered Treatment – Language c hanges added.
Section 2 . 14 – Housing for Individuals Determined to have Serious Mental Illness (SMI) for Central GSA – Language changes regarding SMI members.
Section 4.00 – Covered and Non-Covered Services – Removed moving assistance information.
Section 6.11 - Request for Non-PDL Drugs – Language change regarding AHCCCS Fee-For-Service Prior Authorization criteria.
Section 8.00 - Dental Overview – Corrected DentaQuest address.
Section 18.0 – Provider Requirements for Specific Programs and Services – Updated 5 PSRSPs in this section highlighted in yellow.

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!