Prior Authorization

Codes that require Prior Authorization

A list of codes that require prior authorization are available on our Online Prior Authorization Search Tool.

Learn more about our Prior Authorization process

Mercy Care requires prior authorization for select acute outpatient services and planned hospital admissions. Prior authorization is not required for emergency services. To request a prior authorization, be sure to:

  • Always verify member eligibility prior to providing services.
  • Complete the appropriate authorization form (medical or pharmacy).
  • Attach supporting documentation when submitting. This could include:
    • Recent progress notes documenting the need for the service
    • Lab results
    • Imaging results (x-rays, etc.)
    • Procedure/Surgery reports
    • Notes showing previous treatment tried and failed
    • Specialty notes 

To check on the status of an authorization, please visit our provider secure web portal. For more information about prior authorization, please review Mercy Care's Provider Manuals located under the Provider Information tab on our website.  

You can fax your authorization request to 1-800-217-9345.

Important to Note:  When checking whether a service requires an authorization under Mercy Care’s Online Prior Authorization Search Tool, please keep in mind that a listed service does not guarantee that the service is covered under the plan’s benefits.  Always check plan benefits first to determine whether the service is covered or not.