Information about your health plan
You have access to a lot of information about your plan. And we want to make it easy for you to find what you’re looking for. Click the links below for key information about Mercy Care Advantage.
Looking for an enrollment form or other forms to assist you? You can download any of the forms below at no cost.
- Appointment of Representative Form (English | Español)
- Coverage Determination Form (Online | Print)
- Coverage Redetermination Request Form (Print | Online)
- Enrollment Form (English | Español)
- Enrollment Form Instructions (English | Español)
- Medicare Part D Prescription Claim Form (English | Español)
- Personal Health and Wellness Shop-OTC Order Form (English | Español)
- Personal Medication List
- Prescription Drug Mail-Order Form (English | Español)
- Patient Checklist (English | Español)
- Removal of Authorization Previously Given to Mercy Care Plan (English | Español)
- Request for an Accounting of Disclosures of Protected Health Information (PHI) (English | Español)
- Protected Health Information (PHI) Access Request (English | Español)
- Authorization to Release Psychotherapy Notes (English | Español)
- Authorization to Release Protected Health Information (PHI) (English | Español)
- Scope of Appointment Form (English | Español)
We never want to think about the end of life. But it’s important for everyone to plan for it. Even if you are not sick or injured now, you should consider what kind of care you would want if you were. What if you were unable to express your wishes?
Coordination of Benefits
Coordination of benefits (COB) means using all of your insurance coverages to pay for health care services.
If you have Mercy Care Advantage for your Medicare benefits but enroll in another Medicaid plan, your Medicaid benefits will be provided and paid for by that plan. Your health care providers will need to know you have MCA for Medicare coverage and the other plan for Medicaid (AHCCCS/ALTCS/DDD).
If you have additional health insurance with an employer or a federal program (Tricare), or if you recently lost this coverage, please notify us so we can pay your health care expenses correctly.
Case Management/Disease Management
Do you need help managing your health?
Sometimes you need some extra help to cope with a health issue. That’s why we offer high risk Case Management. A high risk case manager can help you learn how to get the things you need so the next time you can do it on your own.
But not everyone needs a high risk case manager. If they do, most people need a high risk case manager only for a short time. We want you to be able to take care of yourself.
Ask yourself these questions:
- Do you go to the ER a lot?
- Are you having trouble getting things your doctor has ordered?
- Did your doctor just tell you that you have a disease like CHF (congestive heart failure), diabetes, asthma or COPD (chronic obstructive pulmonary disease)?
- Do you need help getting on the Arizona Long Term Care System?
- Do you have HIV or hemophilia?
- Has your doctor said you need a transplant?
- Has your doctor sent you to a specialist, but you don't know what to do?
If you answered "yes" to any of these questions, ask your primary doctor to tell Mercy Care you might need a high risk case manager. Then, a nurse will look at the reason and decide if you need a high risk case manager or if someone else can help you.
If you have one of the following medical conditions: depression, high blood pressure, diabetes, asthma or congestive heart disease, please contact us so we can help you take care of your disease.
Community Information and Referral is an agency that can provide many community resources, such as:
- Help finding a place to live
- Help getting food
- Help buying school clothes for your children
You can also go to the Community Information and Referral website for more information.
Mercy Care Advantage will comply with our Medicare contract obligations and responsibilities when a Federal Disaster or other Public Health Emergency Declaration is issued and impacts our Mercy Care Advantage members.
In this type of situation, Mercy Care Advantage will comply with instructions issued by the government and the state to help ensure members affected by a disaster or public health emergency have access to timely care. This may include waivers to prior authorization requirements and obtaining care from non-contracted providers, if accessing care from contracted providers is not possible. Mercy Care Advantage will take appropriate action steps to keep our members informed when this type of situation occurs.
How to Prepare for a Hospital Admission
Medicare National Coverage Determinations
The Centers for Medicare and Medicaid Services (CMS) released new National Coverage Determinations that affect your coverage. Learn more by selecting a link below.
- Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD)
- Leadless Pacemakers
- Percutaneous Image-Guided Lumbar Decompression (PILD) for Lumbar Spinal Stenosis
- Screening for Hepatitis B Virus (HBV) Infection
- Percutaneous Left Atrial Appendage Closure (LAAC)
- Stem Cell Transplantation
- Cervical Cancer HPV test
- HIV screening
- Speech Generating Devices-Revised
- Microvolt T-Wave Alternans (MTWA)
- Removal of Multiple National Coverage Determinations (NCDs)
- Colorectal Cancer Screening Tests
- Transcatheter Mitral Valve Repair-(TMVR)
- Screening for Hepatitis C Virus (HCV)
- Intensive Cardiac Rehabilitation (ICR) Program
- Cardiac Rehabilitation Programs for Chronic Heart Failure
- Percutaneous Image-Guided Lumbar Decompression (PILD) for Lumbar Spinal Stenosis (LSS)
- Ventricular assist devises for Bridge-to-Transplant and Destination Therapy
- Beta Amyloid (Aβ) Positron Emission Tomography (PET) in Dementia and Neurodegenerative Disease
- Single-Chamber and Dual-Chamber Permanent Cardiac Pacemakers
- Fluorodeoxyglucose (FDG) Positrion Emission Tomography (PET) for Solid Tumors
- Aprepitant for Chemotherapy Induced Emesis
Mercy Care Advantage Rewards
Your health is important to us, and the steps you take to stay healthy deserve a reward!
Mercy Care Advantage Rewards is a program that rewards you for taking care of your health. In this program, you’ll find recommended health care activities —such as preventive screenings and tests — and you can receive rewards for completing them. The more activities you complete, the more you’ll earn!
To enroll, visit the Mercy Care Advantage Rewards website.
Model of Care
Mercy Care Advantage (MCA) is a Medicare Dual-Eligible Special Needs Plan (D-SNP plan) that is available to people with Medicare and Medicaid. As a D-SNP plan, we are required to implement a Model of Care and set goals to help us deliver coordinated care and covered services to our members with special needs. These goals help us identify and track the unique medical needs of our members so we can improve upon the care and services we provide. Each year we evaluate our Model of Care to determine if we have met the quality measures and health outcome goals set. We use the results to make improvements to our Model of Care. If you would like to learn more about our MCA Model of Care or the evaluation process, please contact our Member Services department.
Mercy Care Advantage has been approved by the National Committee for Quality Assurance (NCQA) to operate as a Special Needs Plan (SNP) until 2018 based on a review of the Mercy Care Advantage Model of Care.
New Medicare Card
The Centers for Medicare and Medicaid Services (CMS) are issuing new Medicare cards to people with Medicare from April 2018 to April 2019. Members in Arizona should start to receive their new cards in June 2018.
View the Mercy Care Advantage Privacy Notice English | Español
In May 2016, the Centers for Medicare & Medicaid Services (CMS) approved Mercy Care Advantage to process Seamless Conversion Enrollments. Seamless Conversion Enrollment is an enrollment method that allows Mercy Care Advantage to automatically enroll Mercy Care members who are becoming Medicare eligible due to turning 65 or reaching the end of their 24‐month Medicare disability-waiting period. In October 2016, we began notifying eligible Mercy Care members in writing to explain they will be automatically enrolled in Mercy Care Advantage as of their Medicare entitlement effective date. The notice explains the benefits of being a Mercy Care Advantage member and how this plan will help coordinate with their Mercy Care coverage. Members do have the option to “Opt-Out” of the Mercy Care Advantage plan prior to their enrollment effective date.
Mercy Care Advantage is making outreach calls to eligible members to explain the plan benefits and assist with questions. If you have questions about the Mercy Care Advantage Seamless Enrollment process, please call our Seamless Enrollment team at 1-866-277-1025, (TTY 711), Monday through Friday from 8:00 a.m. – 5:00 p.m.
View an example of the Seamless Enrollment Initial Notice letter.
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