Coverage and care

Coordination of benefits

Coordination of benefits means using all your insurance coverage to pay for care. 

Do you have Mercy Care Advantage for Medicare and another health plan for Medicaid? If so, your Medicaid plan will provide and pay for your Medicaid benefits. Your providers will need to know you have:

• Mercy Care Advantage for Medicare benefits and coverage 
• Another plan for Medicaid benefits and coverage:
  
  
  • Arizona Health Care Cost Containment System (AHCCCS) Complete Care Regional Behavioral Health Agreement (ACC-RBHA)
  • Arizona Long Term Care System (ALTCS)
  • Division of Developmental Disabilities (DDD)

Do you have other insurance with an employer or a federal program (Tricare)? Or have you recently lost coverage? Let us know so we can pay for your health care correctly.

Model of care 

As a Medicare dual-eligible special needs plan (D-SNP), we rely on a model of care. We set goals to help us provide coordinated care and services to our members with special needs. These goals help us track the needs of our members. Each year we review our model of care to make sure we’ve met our quality and health outcome goals.  We use the results to improve our services and model of care.  

Want more info on our model of care or the review process? Call us at ${MCA_MS_phone_1} or ${MCA_MS_phone_2} (TTY 711). We're here for you ${MCA_MS_hours}. The Centers for Medicare & Medicaid Services (CMS) has approved our model of care through December 31, 2024.

Medicare National Coverage Determinations

CMS released national coverage determinations that affect your coverage. Choose a year and topic to learn more.

Clinical practice guidelines

We’ve chosen certain clinical guidelines to:

• Help our providers give you consistent, high-quality care
• Ensure good use of services and resources
• Provide treatment protocols for specific conditions, as well as preventive health 

These guidelines clarify our standards and expectations. They should not:

• Come before your provider’s responsibility to provide treatment based on your needs
• Substitute as orders for your treatment 
• Guarantee coverage or payment for the type or level of care your provider advises

We have adopted these guidelines for adults. Need to learn more about the guidelines? Check the topics and links that follow.