News and Events

COVID-19 Frequently Asked Questions

Mercy Care has been monitoring the outbreak of the novel Coronavirus, also known as COVID-19, very closely in conjunction with our state and federal regulators, the Centers for Disease Control (CDC) and the World Health Organization (WHO). Medical experts are encouraging “social distancing” as a way to reduce the number of individuals who become ill. Mercy Care believes that it is important for us as a health care company to commit to this approach. Mercy Care has prepared the following FAQs, based on information we have received from our regulators and questions we have received from our provider network. Please note that this is a living document and will be updated as new information and/or questions arise.

Telehealth/Telemedicine

Posted 3-31

Q1. How will FQHCs be reimbursed for telemed services? 

A1. Refer to AHCCCS Telehealth FAQ

Posted 3-24

Q1. Will Mercy Care provide guidance for when Long Term Care and non-Long Term Care members cancel wound care appointments? We cannot do these via phone or telehealth. 

A1.  Clinical staff (nursing/provider) should evaluate the member and provide standard of care for wound management. If a member needs an evaluation by a specialist, you should refer the member to the appropriate in-network provider for wound management. You can refer to an out-of-network when in-network services are not available. Clinical staff can also look into telehealth services/telephonic services, as appropriate, to meet member needs. Telehealth resources link:  https://www.azahcccs.gov/AHCCCS/AboutUs/covid19FAQ.html#telehealth

Posted 3-23

Q1.  Under the new Coronavirus guidelines, can behavioral health in-home assessments be done virtually for Mercy Care members? (ACC, ALTCS, DD, MCA, RBHA) 

A1. Beginning on March 6, 2020, Medicare — administered by the Centers for Medicare & Medicaid Services (CMS) — will temporarily pay clinicians to provide telehealth services for beneficiaries residing across the entire country. 

See the following sites for more details:  To read the fact sheet on this announcement, visit: https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet. To read the frequently asked questions on this announcement, visit: https://www.cms.gov/files/document/medicare-telehealth-frequently-asked-questions-faqs-31720.pdf

Q2:  What is Mercy Care’s policy on telehealth?

A2:  Many in our provider network have been asking for guidance for billing telehealth claims during this COVID-19 emergency. We are following AHCCCS telehealth guidelines, which are being frequently updated. You can find them here: https://www.azahcccs.gov/Resources/Downloads/DFMSTraining/2019/TelehealthServicesBillingGuidelinesFFSPresentation.pdf

You can also refer to Mercy Care’s provider notification: https://myemail.constantcontact.com/COVID-19-Emergency-Medical-Coding-Guidance-from-AHCCCS.html?soid=1118183724642&aid=KKkJ-ZOjM20

Q3.  Has Mercy Care made any changes regarding telemedicine?

A3. Mercy Care is following AHCCCS and CMS guidelines. For all telehealth services and billing guidelines, you can refer to those telehealth guidelines at:

https://www.azahcccs.gov/Resources/Downloads/DFMSTraining/2019/TelehealthServicesBillingGuidelinesFFSPresentation.pdf

https://www.cms.gov/files/document/medicare-telehealth-frequently-asked-questions-faqs-31720.pdf

Q4.  I understand that we do not have the availability to schedule intakes via telehealth as H0031 does not allow a POS of 2. I, however, am so concerned about the families we have accepted and now are leaving without any services. This just feels yucky as they are probably the families that need us most. I understand that base agencies could provide support, however, I am wondering if we could initiate services. My question is, could we complete an intake and no bill it so we could engage in telehealth support for caregivers and rises support? Specifically, I am wondering if I could conduct a telehealth intake and not bill it. This way, I could have the chart opened and the intake completed so that we could engage in telehealth sessions. Just a thought on how to ensure families’ needs are met.

A4. AHCCCS is temporarily allowing H0031 with POS 12. 

Q5.  Do we need a new prior authorization to perform the function at the HOME (12) place of service rather than the office place of service?

A5.  New authorizations are not required.

Posted 3-19

Q1. Is Mercy Care Advantage allowing telemedicine services for its members now?

A1. On March 17, the Trump Administration announced expanded Medicare telehealth coverage that will enable beneficiaries to receive a wider range of healthcare services from their doctors without having to travel to a healthcare facility. Beginning on March 6, 2020, Medicare — administered by the Centers for Medicare & Medicaid Services (CMS) — will temporarily pay clinicians to provide telehealth services for beneficiaries residing across the entire country.

To read the fact sheet on this announcement, visit: https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet

To read the frequently asked questions on this announcement, visit: https://www.cms.gov/files/document/medicare-telehealth-frequently-asked-questions-faqs-31720.pdf

This guidance, and earlier CMS actions in response to the COVID-19 virus, are part of the ongoing White House Task Force efforts. To keep up with the important work the task force is doing in response to COVID-19 click here www.coronavirus.gov. For information specific to CMS, please visit the Current Emergencies Website.

Posted 3-18

Q1. Traditionally, the Medicare Advantage plans do NOT cover telehealth services unless the patient resides in a rural and underserved location. Will Mercy Care Advantage cover telehealth services during the COVID-19 crisis?

A1. On March 17, the Trump Administration announced expanded Medicare telehealth coverage that will enable beneficiaries to receive a wider range of healthcare services from their doctors without having to travel to a healthcare facility. Beginning on March 6, 2020, Medicare — administered by the Centers for Medicare & Medicaid Services (CMS) — will temporarily pay clinicians to provide telehealth services for beneficiaries residing across the entire country.

To read the Fact Sheet on this announcement, visit: https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet

To read the Frequently Asked Questions on this announcement, visit: https://www.cms.gov/files/document/medicare-telehealth-frequently-asked-questions-faqs-31720.pdf

This guidance, and earlier CMS actions in response to the COVID-19 virus, are part of the ongoing White House Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19 click here www.coronavirus.gov. For information specific to CMS, please visit the Current Emergencies Website.

Q2. Are we able to engage clients via telephone/teleconference and bill services under the following codes? Individual Therapy H0004; Family Therapy w/ Client H0004 HR; Family Therapy without Client H0004 HS

A2. For all telehealth services and billing guidelines, you can refer to AHCCCS telehealth guidelines at: https://www.azahcccs.gov/Resources/Downloads/DFMSTraining/2019/TelehealthServicesBillingGuidelinesFFSPresentation.pdf

Q3. How can telehealth services be provided specifically through direct support services such as their Meet Me Where I Am (MMWIA) Program?

A3. For all telehealth services and billing guidelines, you can refer to AHCCCS telehealth guidelines at: https://www.azahcccs.gov/Resources/Downloads/DFMSTraining/2019/TelehealthServicesBillingGuidelinesFFSPresentation.pdf

Q4. Can the following codes be billed for telephonic service? H0004, 99213, 99214, 99215. If not, who can I reach out to at Mercy Care to determine whether an exception can be granted for patient and member care? 

A4. For all telehealth services and billing guidelines, you can refer to AHCCCS telehealth guidelines at: https://www.azahcccs.gov/Resources/Downloads/DFMSTraining/2019/TelehealthServicesBillingGuidelinesFFSPresentation.pdf

Q5. Has Mercy Care come up with a Telemedicine Policy that can help providers draft their own to address the ongoing issues with COVID-19?

A5. For all telehealth services and billing guidelines, you can refer to AHCCCS telehealth guidelines at: https://www.azahcccs.gov/Resources/Downloads/DFMSTraining/2019/TelehealthServicesBillingGuidelinesFFSPresentation.pdf

Q6. What can be done and/or approved for telehealth services specifically through direct support services (ABA Services)?

A7. For all telehealth services and billing guidelines, you can refer to AHCCCS telehealth guidelines at: https://www.azahcccs.gov/Resources/Downloads/DFMSTraining/2019/TelehealthServicesBillingGuidelinesFFSPresentation.pdf

Q8. Which codes can be billed telephonically or via telehealth?

A8. For all telehealth services and billing guidelines, you can refer to AHCCCS telehealth guidelines at

https://www.azahcccs.gov/Resources/Downloads/DFMSTraining/2019/TelehealthServicesBillingGuidelinesFFSPresentation.pdf

Q9. Before we roll out our aggressive plan to expand telehealth services for our outpatient clinic and at facilities, we need to know where we can get clarity if telehealth services will be covered.

A9. For all telehealth services and billing guidelines, you can refer to AHCCCS telehealth guidelines at

https://www.azahcccs.gov/Resources/Downloads/DFMSTraining/2019/TelehealthServicesBillingGuidelinesFFSPresentation.pdf

On March 17, The Trump Administration announced expanded Medicare telehealth coverage that will enable beneficiaries to receive a wider range of healthcare services from their doctors without having to travel to a healthcare facility. Beginning on March 6, 2020, Medicare — administered by the Centers for Medicare & Medicaid Services (CMS) — will temporarily pay clinicians to provide telehealth services for beneficiaries residing across the entire country.

To read the Fact Sheet on this announcement visit: https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet

To read the Frequently Asked Questions on this announcement visit: https://www.cms.gov/files/document/medicare-telehealth-frequently-asked-questions-faqs-31720.pdf

This guidance, and earlier CMS actions in response to the COVID-19 virus, are part of the ongoing White House Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19 click here www.coronavirus.gov. For information specific to CMS, please visit the Current Emergencies Website.

 

Posted 3-17

Q1: Where can I find more information regarding telehealth services and billing guidelines?

A1: You can find AHCCCS telehealth services and billing guidelines at this link: https://www.azahcccs.gov/Resources/Downloads/DFMSTraining/2019/TelehealthServicesBillingGuidelinesFFSPresentation.pdf (PDF)

Q2. What codes can be used when services are provided telephonically?

A2: The following codes can be used when services are provided telephonically: 98966, 98967, 98968, 99441, 99442, 99443, H0025, H0038, H2014, H2025, S5110 and T1016. When providing services telephonically, providers are required to list the place of service (POS) as 02.

Q3: How can a provider request the addition of POS 02 for additional codes?

A3: To request the addition of POS 02 for additional codes, contact CodingPolicyQuestions@azahcccs.gov.

Q4: Is Mercy Care allowing only Evaluation and Management (E&M) codes for telehealth services?

A4: Mercy Care follows the National Coding Guidelines. For more information, visit https://www.azahcccs.gov/Resources/Downloads/DFMSTraining/2019/TelehealthServicesBillingGuidelinesFFSPresentation.pdf (PDF)

Q5: Has Mercy Care waived the requirement for in-person staffings?

A5: Yes. Mercy Care encourages providers to conduct virtual staffings to the extent possible.    

Q6: What direction has Mercy Care given to its case managers?

A6: All visits should be conducted virtually as much as possible.

Q7: Are case managers still doing in-person visits?

A7: As noted above, all visits should be conducted virtually as much as possible.

Q8: Will providers be able to conduct all client in-person visits (Enrollments, 5 Day, 30 Day, 90 Day) over the phone, rather in the client’s home, until further notice?

A8: Yes. Visits should be done telephonically until further notice.

Transportation

Posted 4-6

Q1.  Does Mercy Care have any recommendations for non-emergent transportation of a person with known COVID-19 infection? 

A1.   A person with a known COVID-19 infection, or symptomatic respiratory illness suspicious for COVID-19 infection, should be transported by a non-emergent ambulance because they will need to have the type of personal protective equipment and procedures for both the patient and the crew.  Emergency transportation should be done by emergency responders who will already have this capacity. For Mercy Care members, providers should call our Member Services Department and the appropriate level of transportation will be arranged. You can reach member services for Mercy Care Complete Care at 602-263-3000 and Mercy Care RBHA at 602-586-1841.

Prior Authorization

Q1. Is Mercy Care using a claims modifier for services related to the COVID-19 emergency? 

A1. Yes. Mercy Care has designated the CR modifier to be used on all claims for services provided as a result of or related to COVID-19. It is imperative that providers begin utilizing this modifier immediately in all appropriate instances for Mercy Care to identify the costs of services attributable to this emergency, and to help override prior authorization requirements for those services directly related to COVID-19 treatment.  All other guidance regarding use of modifiers continues to be applicable. 

Q2. During the COVID-19 emergency period, how do providers handle the informed consent requirements and treatment plan agreements/signatures and/or other documents that require a member or guardian's written consent, agreement and/or signature if they are providing services via telehealth or telephone? 

A2. During the COVID-19 emergency, providers delivering services through telehealth and telephonic means can obtain verbal consent and verbal treatment plan agreements and document the Member's/Guardian's verbal consent and verbal agreement in the Electronic Medical Record (EMR). It will not be necessary to gather retroactive signatures once the COVID-19 emergency period ends provided the documentation is in the EMR. 

 

DME 

Q1. Are pharmacy supplies and durable medical equipment (DME) supplies available for 90-day fills? 

A1. Yes. Supplies, including but not limited to insulin pump supplies, glucose testing strips, lancets, syringes, tubing and other supplies for sleep apnea equipment, nutritional supplements, and incontinence briefs are available for 90-day fills. 

 

Q2. Will AHCCCS allow providers to bill with future dates in order to fulfill a 90-day supply for DME?  

A2. Mercy Care is waiting for further guidance from AHCCCS. 

 

For DME evaluations: In-person evaluations will not be required for DME requests. Information obtained via telephonic or telehealth is strongly encouraged and accepted. 

 

Out of Network Services 

Q1. I am a non-contracted provider for Mercy Care. Can I provide telehealth and office visits as a non contracted provider?  

A1. If you are registered with AHCCCS, yes. Mercy Care must reimburse AHCCCS registered in-network and out-of-network providers for services related to testing, diagnosis, and/or treatment of COVID19 as outlined in ACOM 203. Mercy Care has designated the CR modifier to be used on all claims for services provided as a result of or related to COVID-19. It is imperative that providers begin utilizing this modifier immediately in all appropriate instances for Mercy Care to identify the costs of services attributable to this emergency and to help override prior authorization requirements for those services directly related to COVID-19 treatment.    

Q2. Will non-contracted providers require authorization?  

A2. Mercy Care will not require prior authorization or concurrent review for services related to testing, diagnosis, and/or treatment of COVID-19. Mercy Care has designated the CR modifier to be used on all claims for services provided as a result of or related to COVID-19. It is imperative that providers begin utilizing this modifier immediately in all appropriate instances for Mercy Care to identify the costs of services attributable to this emergency and to help override prior authorization requirements for those services directly related to COVID-19 treatment.   

Q3. What if the services are not related to COVID-19?  

A3. Services NOT related to COVID-19, including telehealth, must be performed by a Mercy Care in-network provider.  

Q4. What if the services are related to COVID?  

A4. Mercy Care will reimburse AHCCCS-registered in-network and out-of-network providers for services related to testing, diagnosis, and/or treatment of COVID-19 as outlined in ACOM 203.  

 

General Prior Authorization Questions 

Q1. Will Mercy Care consider relaxing the mandatory 72-hour turnaround time for Behavioral Health Residential Facility (BHRF) prior authorization (PA) determinations due to high volume and possible capacity issues? 

A.1 No, as there are concerns that expanding the 72-hour turnaround time on BHRF determinations could impact the continuity of care between inpatient facilities and transitions into the community. This is per AHCCCS Guidance. 

Q2. Does Mercy Care have guidance about Prior Authorization (PA) and Concurrent Review procedures during the COVID-19 emergency? 

A2. Yes. please see the AHCCCS March 23, 2020 memo. Mercy Care is following AHCCCS guidance.  

Q3. Will Mercy Care be extending approved prior authorizations?  

A3. Mercy Care has extended all outpatient service prior authorization approvals which were within 60 days of expiration out for 6 months. 

Q4. Will Mercy Care be extending approved elective IP surgeries?  

A4. Answer: Mercy Care has extended all elective IP surgery approvals which were within 60 days of expiration out for 6 months. 

Q5. Does Mercy Care require prior authorization for Observation/Acute IP admissions?   

A5. During the COVID-19 emergency, Mercy Care will remove any prior authorization and concurrent review requirement. Please continue to notify Mercy Care of admission so that we can help with discharge planning needs.  

Q6. Is prior authorization required for the following admissions types?  

A6. Prior Authorization is not required but concurrent review is maintained for these levels of care: 

• Assisted Living Facilities/Centers 
• Skilled Nursing Facilities (SNFs) 
• Inpatient Rehabilitation Facilities 
• Long Term Acute Care Hospitals 

 

Q7. Will Mercy Care still require prior authorization for Residential Treatment Center (RTC), Behavioral Health Residential Facility (BHRF) and Therapeutic Foster Care (TFC) levels of care? 

A7.  Yes. Prior authorization is still required for these types of BH services. Clinical staffings, Child and Family Teams (CFTs), Adult Recovery Team (ARTs), and coordination of care between facilities and outpatient providers should continue to inform appropriate levels of care and continued stay. Telehealth and telephonic modalities are strongly encouraged for these staffings and coordination. 

Q8. Will Mercy Care issue guidance regarding prior authorization expectations related to COVID-19 testing and treatment? 

A8. Prior authorization is not permitted for COVID-19 testing or treatment. Mercy Care has designated the CR modifier to be used on all claims for services provided as a result of or related to COVID-19. It is imperative that providers begin utilizing this modifier immediately in all appropriate instances for Mercy Care to identify the costs of services attributable to this emergency and to help override prior authorization requirements for those services directly related to COVID-19 treatment.   

Q9. Will Mercy Care be relaxing PA requirements for services not related to COVID-19? 

A9. Services not related to COVID 19 will continue to follow the current PA requirements. Non-COVID-19 services (including telehealth} must be done by a Mercy Care in-network provider. Services must be rendered by in-network providers as available. If no in-network providers are available, providers are to follow PA requirements and Mercy Care will review them on a case-by-case basis. 

Dental  

Q1. Will Mercy Care be extending approved dental services for an additional 6 months?  

A1. Yes. All Mercy Care dental prior authorization approvals which are within 60 days of expiration are being extended for 6 months. 

Q2. What happens if the member turns 21 during this extended authorization timeframe and the member is no longer covered for those approved services?  

A2. Mercy Care has sent this question to AHCCCS for further guidance. 

Q3. Will Mercy Care be relaxing authorization requirements for dental services? 

A3. Mercy Care is removing prior authorization for the following dental codes: 

• D7140 through D7270 
• D2930 
• D2931 
• D3220 
• D3230 
• D3240 
• D3310 through D3330 
• D0330 (under 6) 

Pharmacy/Prescriptions MEDICAID

ARIZONA STATE BOARD OF PHARMACY COVID-19 FAQS - https://pharmacy.az.gov/

Posted 4-2

In an effort to address preparedness for COVID-19 Mercy Care has made the following changes to the prescription pharmacy benefit:

Refill-too-soon edit removed on all non-controlled medications

• Member may continue to fill prescriptions for up to a 30-day supply or they may fill a 90-day supply of maintenance medications at a Mercy Care contracted retail or mail order pharmacy.
• Providers can encourage members to sign up with CVS mail-order pharmacy. Members can sign up by mail or online.

By mail
They can request a mail-order form by calling Mercy Care Member Services at 1-800-624-3879 (TTY/TDD 711) or Mercy Care RBHA Member Services at 1-800-564-5465 (TTY/TDD 711). Or, they can download and print the mail-order form here: English | Spanish

Online
They can also register for mail order with CVS Caremark at www.caremark.com 

Controlled Substances may be refilled early when the pharmacy staff has checked with the prescribing clinician and the clinician has agreed to the early refill.  The pharmacy staff or the prescribing clinician shall contact the pharmacy help desk for an immediate override

• CVS Pharmacy Help Desk (ACC, DD, ALTCS): 1-855-548-5646
• CVS Pharmacy Help desk (RBHA): 1-855-319-6295

Prior authorizations on most medications that were set to expire by May 20, 2020, were extended for an additional 90 days. The pharmacy may have to contact the provider for an approval to request a fill of an expired prescription, but a prior authorization will not have to be submitted during the 90-day prior authorization extension.

Waived copayments on prescriptions for those Mercy Care Medicaid members who previously had copayments on prescriptions. This change does not apply to Mercy Care Advantage members and covered Part D prescription copays.

Prior authorizations removed for the following Therapeutic Classes: 

• Antibiotics
• Antimalarials
• Antivirals 
• Beta2 Agonist Inhalers, Inhalant Solutions an Oral Agents
• Inhaled Short and Long Acting Anticholinergic Inhalers
• Long-acting Beta2 Agonist-Corticosteroid Combination Inhalers
• Long-acting Beta2 Agonist-Anticholinergic Combination Inhalers
• Corticosteroid Inhalers and Inhalant Solutions
• Corticosteroid Oral Agents
• Nebulizers
• Cough and Cold products 
  • Antihistamines
  • Nasal Decongestants
  • Combination products of antihistamines and nasal decongestants
  • Cough suppression products including guaifenesin and combination products
  • Guaifenesin oral tablets and combination products
  • Analgesics / Anti-febrile products (aspirin, ibuprofen, acetaminophen, acetaminophen suppositories, etc.)
• Mast Cell Stabilizers
• Methylxanthines (aminophylline and theophylline

ProAir and Oseltamivir may be in short supply, so Mercy Care is allowing all federally and state reimbursable generic and brand products for albuterol inhalers and Tamiflu/Oseltamivir (capsules & suspension) to be reimbursable through the point-of-sale system without prior authorization.

Free prescription delivery:

• CVS pharmacies will deliver most medications. They will not deliver controlled substances or refrigerated products.
• To find a pharmacy that is open 24 hours or has Prescription Delivery available, you can use our pharmacy search tool:

Pharmacy search tool to find a network pharmacy

Posted 3-23

Q1.  How can providers assist members in getting their prescriptions filled timely during the COVID-19 crisis? 

A1. Providers should encourage members to sign up with CVS mail-order pharmacy. Members can sign up by mail or online.

By mail
They can request a mail-order form by calling Mercy Care Member Services at 1-800-624-3879 (TTY/TDD 711) or Mercy Care RBHA Member Services at 1-800-564-5465 (TTY/TDD 711). Or, they can download and print the mail-order form here: English | Spanish

Online
They can also register for mail order with CVS Caremark at www.caremark.com.

Posted 3-17

Q1: Will Mercy Care allow a 30-day prescription for a controlled substance to be filled early?

A1: Yes, the pharmacy staff may contact the prescribing clinician to request approval for the early refill. If the prescribing clinician approves the early refill, the pharmacy staff will contact Mercy Care’s Pharmacy Benefit Manager (PBM) Help Desk for an override.

Q2: Will Mercy Care will allow pharmacies to override the refill-too-soon edit on prescriptions?

A2: Mercy Care will continue to allow most prescriptions to be filled as a 90-day mail order supply and will be extending this to retail pharmacies. This does not apply to opioids, home infusion or crisis.  

Q3: Is CVS offering free prescription home delivery from each of its locations?

A3: Yes.

 

Pharmacy/Prescription MEDICARE

Posted 4-11

General Comments for MCA Part D Prescription Drug Coverage  

• Authorizations set to expire in March and April were extended for an additional 90-days.
• MCA members are responsible to pay their Part D copays for covered drugs. MCA members qualify for low income subsidy assistance to help pay for their covered Part D drugs.

Q1.  How can providers assist members in getting their prescriptions filled timely during the COVID-19 crisis? 

A1. Providers should encourage members to sign up with CVS mail-order pharmacy. Members can sign up by mail or online.

By mail
They can request a mail-order form by calling Mercy Care Advantage Member Services at 602-586-1730 or 1-877-436-5288 (TTY 711). 8:00 a.m. - 8:00 p.m. 7 days a week.   Or, they can download and print the mail-order form here: English | Spanish

Online
They can also register for mail order with CVS Caremark at www.caremark.com.

Q2: Will Mercy Care allow pharmacies to override the refill-too-soon edit on prescriptions?

A2:  Yes, edits for early refill limits on 30-day prescription maintenance medications have been waived. MCA members can get a 90-day supply of maintenance medications at participating retail pharmacies.

Q3: Will Mercy Care allow a 30-day prescription for a controlled substance to be filled early?

A3: Yes, the pharmacy staff may contact the prescribing clinician to request approval for the early refill. If the prescribing clinician approves the early refill, the pharmacy staff will contact Mercy Care’s Pharmacy Benefit Manager (PBM) Help Desk for an override.

Q4: Is CVS offering free prescription home delivery from each of its locations?

A4: Yes.

Q5: Can MCA members who are out of state fill a prescription?

A5: Yes, if an MCA member is out of state and requires covered Part D drugs, they can fill their prescription at any pharmacy participating in the CVS national pharmacy network.

Long Term Care

Posted 3-17

Q1: The Centers for Medicare and Medicaid Services (CMS) has issued a directive to limit visitors in long term care facilities at this time. What does this mean for Mercy Care members?

A1: Limiting visitors means that individuals will not be allowed to come into the facility, except in certain situations, such as end-of-life situations or when a visitor is essential for the resident’s emotional well-being and care.

Q2: How can families get status updates on facilities visitation policies and on the status of their loved ones? A10: Mercy Care encourages families to call facilities daily for status updates on their loved one and for updates to the visitation policy.

Q2: How can families communicate with their loved ones? A11: All residents have access to a phone in their rooms. Mercy Care encourages family members to call and talk with their family members as often as they would like. Mercy Care also encourages the use of video calling, such as FaceTime or Skype, if their loved one has a cell phone with them. Many facilities also have tablets/iPads residents can use to FaceTime or video chat.

SMI Clinic Provider Questions

Below find a list of Mercy Care Regional Behavioral Health Authority recommendations related to member care for individuals enrolled with an outpatient clinic for adults with a serious mental illness (also known as an SMI clinic).

When provider staff are working with internal/external stakeholders and members, Mercy Care strongly encourages following the guidelines on hygiene, social distancing, and use of personal protective equipment as set forth by the below organizations:

1. CDC - https://www.cdc.gov/coronavirus/2019-ncov/index.html
2. ADHS – https://www.azdhs.gov/
3. AHCCCS - https://www.azahcccs.gov/AHCCCS/AboutUs/covid19.html
4. Maricopa County Department of Public - https://www.maricopa.gov/5302/Public-Health

If you are unable to meet these guidelines, you should stop and seek assistance.

Recommendations

1. Clinical team should provide transportation upon member discharge from a hospital to ensure members have access to their discharge medications. Natural supports can be utilized as a first option, however the same timelines for hospital follow up visits apply, though it is recommended these be conducted telephonically/telehealth if clinically appropriate.
   
   
2. Clinical team should provide transportation to psychiatric hospitals when a member needs inpatient treatment.
   
   
3. Clinical team should be present upon release from jail.
   
   
4. Behavioral Health Medical Professional (BHMP) visits should be completed via tele-health or phone and in person as clinically indicated.
   
   
5. Face-to-Face (F2F) visits should still occur if a member is experiencing a crisis in a community setting.
   
   
6. Routine F2F case management visits should be completed telephonically/telehealth or in person as clinically indicated for members who have high acuity symptomology.
   
   
7. Safety/well checks should occur F2F. 
8. Clinical teams should transport members from and to crisis/sub-acute settings. 
   
   
9. ASSERTIVE COMMUNITY TREATMENT(ACT) TEAMS ONLY: If approved by BHMP, for those members on medication observation this can be completed via telehealth if clinically appropriate. Other members should be completed F2F as ordered by the ACT team BHMP.
   
   
10. IHH ONLY: Primary Care Physician (PCP) visits should continue via telehealth if available. F2F visits should still occur if clinically indicated by PCP.
    
    
11. The following services are recommended to be completed, if clinically appropriate, via telephone/telehealth:
    • Psych Evals
    • Assessments/Individual Service Plans
    • Routine Case Management
    • BHMP
    • PCP
    • Counseling
    • Medication Management by BHMP
12. Clinics are asked to refrain from using crisis facilities for what would typically be a non-emergency outpatient appointment, such as lab work or long acting injections.
    
    
    
13. Regarding members under outpatient Title 36 Court Ordered Treatment (COT), the condition of the member on COT must be assessed at least once every 30 days and the findings of the assessment must be documented by the BMHP in the medical record. During the COVID-19 pandemic, the BHMP may use telehealth as the first choice; if the member does not have the equipment for this, then phone call/facetime would be the second choice as long as the BHMP conducting via either method is able to determine if the member is compliant with the outpatient treatment plan. The BHMP needs to consider all reports and information received (lab reports, check with pharmacy to see if meds were picked up, attendance for injections, checking with collateral sources such as probation or family, etc.). Based on the assessment, the BHMP may then require the patient to report in person for further evaluation at the outpatient COT provider. 
    
    
14. Regarding Case Manager face to face, during the COVID-19 pandemic, phone contact or facetime is approved again with documentation of the call and results. 

 

From AHCCCS COVID-19 FAQs:

(added 4/3/20)

1. Question: How does Governor Ducey’s March 24th Executive Order freezing all evictions in Arizona related to COVID for 120 days affect persons determined Seriously Mentally Ill (SMI) or persons with behavioral health needs (GMH/SU) in AHCCCS supported residential programs, including Permanent Supportive Housing, and/or Behavioral Health Residential Facilities (BHRFs), in which members pay room and board?

Answer: AHCCCS intends for the Executive Order to apply to all AHCCCS and/or Medicaid funded permanent supportive and transitional housing programs as well as services settings in which AHCCCS members pay for room and board such as BHRFs, assisted living facilities, and group homes. Residential stability is critical for members to comply with mandated stay at home orders. To this end, there should be no disruption of service or alteration of existing subsidies for persons residing in AHCCCS funded Permanent Supportive and Transitional Living programs for persons determined SMI. Similarly, these protections should be broadly applied to any service setting whereby AHCCCS members pay for room and board.

 

In all situations during this crisis, AHCCCS encourages increased care coordination of members with behavioral health needs in housing or residential programs/settings to ensure housing/placement security during this crisis. This will allow members to maintain their residential setting and comply with social distancing and stay at home practices required under our State and National COVID response orders for their own health and the health of our community.

 

SAMHSA Provider Training Resource: https://www.samhsa.gov/sites/default/files/training-and-technical-assistance-covid19.pdf

General

Posted 4-30

Q1.  Will Community Service Agencies (CSAs) be able to bill T1016 during the COVID-19 crisis? 

A1.   At this time AHCCCS is not adding T1016 to the CSA provider type.  H0038 (self-help/peer services per 15 minutes) can be utilized for this purpose throughout the course of the COVID-19 emergency. 

Posted 4-23

Q1.  If a member presents for care and has primary commercial insurance coverage with Medicaid as their secondary insurer, are we required to provide care? 

A2. Yes.  Coordination of Benefits has not been impacted or changed as a result of the COVID-19 pandemic.  Providers should treat the member and follow the COB process as outlined in Mercy Care’s Provider Manual.   

Posted 3-31

Q1. Is Mercy Care expecting any disruptions with claims processing/payments caused by the COVID-19?  

A1. Our claims processing system is already configured to receive claims using the new codes.  We are still working for final configuration to pay the services as directed by AHCCCS.  Our configuration team is working on these updates as their highest priority.  If any unforeseen issues arise that prevent the claims from paying the correct rates at the time of adjudication, we may pend claims in the interim.

Posted 3-27

Q1: Providers have expressed concerns about the availability of personal protective equipment (PPE). What resources are available? How can providers obtain some of the FEMA allocated PPE? 

A1: The Arizona Department of Health Services has issued this COVID-19 Infection Control and Personal Protective Equipment (PPE) Guidance for Arizona. The FEMA allocated PPE initially comes through ADHS and then is distributed to county health departments. Providers are to submit requests directly to their County Health department. See this provider guidance from Maricopa County. 

Posted 3-26

Q1.  Is there a centralized resource for medical coding resources related to COVID-19?

A1.   Yes.  Refer to Medical Coding Resources, which includes a COVID-19 Medical Coding Information section  

Posted 3-24

Q1.  What personal protective equipment (PPE) are providers advised to wear during in-person visits? If providers can’t find the supplies on their own, where can they get assistance to obtain supplies?

A1.  Maricopa County Department of Public Health has detailed information about PPE availability, its recommended use, and alternative strategies and resources. You can get more information here:

• Maricopa County Department of Public Health: 
  https://www.maricopa.gov/5491/Healthcare-Provider-Guidance
• AHCCCS: https://www.azahcccs.gov/AHCCCS/AboutUs/covid19FAQ.html#telehealth (See question #38, which has links to PPE guidance)
• Also regularly check with Maricopa County Department of Public Health and Centers for Disease Control and Prevention (CDC) for the latest guidance.

Posted 3-23

Q1.  Are there any standard protocols for infection control for patients with suspected COVID-19 symptoms in a behavioral health (BH) care setting?

A1. You should follow CDC guidelines, which you can find here: https://www.cdc.gov/coronavirus/2019-ncogv/faq.html

Posted 3-19

Q1. Will Mercy Care provide guidance for the community on what can be done about members who present to a behavioral health (BH) hospital for behavioral health issues and either develop COVID-19 symptoms while there, or present with COVID -19-like symptoms upon admission?

A1.  We recommend all health care providers follow the CDC guidelines for health care providers at https://www.cdc.gov/coronavirus/2019-ncov/faq.html.

The Maricopa County Department of Public Health also has excellent resources for health care providers and facilities: https://www.maricopa.gov/5491/Healthcare-Provider-Guidance

Q2. What direction has Mercy Care given to its health care providers about case management visits? 

A2. All visits should be conducted virtually as much as possible. When an in-person visit is necessary, the case manager should follow the CDC guidelines for health care providers and facilities at https://www.cdc.gov/coronavirus/2019-ncov/faq.html

Q3. Will Mercy Care do provisional credentialing for new subacute locations; will it fund for out-of-state staff to support services during this time?

A3. Mercy Care will be conducting provisional credentialing, as directed by AHCCCS.  Additionally, for recredentialing of providers that do not have any quality or utilization concerns, Mercy Care will also follow AHCCCS guidelines to offer some flexibility in the recredentialing timelines (up to six months). 

Q4. Will Mercy Care still conduct onsite quality monitoring?

A4. Mercy Care will conduct desk audits (to the extent possible). In addition, AHCCCS is developing a standardized provider attestation statement that providers can sign off on in lieu of the visit, until such time that the onsite quality monitoring can be conducted.  The attestation statement will be sent once it is fully vetted by AHCCCS.  

Q5. Does the recent notice about Mental Health Court continuing cases or allowing case managers to appear by telephone for the next 60 days affect COE-COT hearings at Valleywise?

A5. The announced 60-day continuance or telephonic appearance for cases pertains only to criminal matters. This does not apply to Title 36 Civil Commitment (COE/COT) cases.

Q6. Where can providers find information about lab testing?

A6. If you are using our contracted laboratory, Sonora Quest Laboratory, they have a site for providers on the procedures for testing.   Please visit their website at: https://www.sonoraquest.com/covid-19-information-for-healthcare-providers/ 

For additional information, you may also visit the Centers for Disease Control: https://www.cdc.gov/coronavirus/2019-ncov/lab/index.html

Posted 3-18

Q1. Is the Language Line still available and how do providers access it?

A1. The Language Line is always available, is easy to use on any phone and can connect you to an interpreter within seconds, 24/7/365. 

• Dial the provided toll-free telephone number from any phone
• Provide basic account information and identify the language
• Connect to an interpreter within seconds 
• Our interpreter can dial an outbound call to connect your LEP client if needed
• Customizable process streamlines your call flow, improves efficiency to meet your specific business needs
• You can refer to our Language Line Solutions Quick Reference Guide for call-in detail. You’ll need to enter the appropriate 4-digit PIN code:

Clinical 
Mercy Care Complete Care, Mercy Care Long Term Care, Mercy Care DD and Mercy Care Advantage - Clinical – 1203
Mercy Care RBHA - Clinical – 2076

Non-clinical
Mercy Care Complete Care, Mercy Care Long Term Care, Mercy Care DD and Mercy Care Advantage - Non-Clinical – 1204
Mercy Care RBHA - Non-Clinical – 1205

As a reminder, if you cancel an appointment with a member who was scheduled to have in-person interpretation services, make sure you also cancel the member's appointment with interpretation services. 

Q2: What direction has Mercy Care given to its health care providers about Case Management visits? 

A2: All visits should be conducted virtually as much as possible. When in-person visit is necessary, the Case Manager should follow the CDC Guidelines for health care providers and facilities.

Q3. Does Mercy Care have any guidance or expectations when someone at our site (member or staff) tests positive for COVID-19?

A3. The CDC has provided guidance. See links below:

• Healthcare Facilities CDC Guidelines
• Preventing Spread in Long Term Care Facilities

Q4. In the event there is an order to shut down all services, is there a generally accepted practice to ensure clients are able to continue to receive their medications (e.g Members who come into the clinics for injections)? What would be the industry standard/expectation for ensuring these clients continue to receive medications?

A4. We will follow ADHS and CDC direction as they provide it.

Posted 3-17

Q1: What personal protective equipment (PPE) are staff advised to wear during the in-person visits if they are able to still conduct in-person visits?

A1: Staff are encouraged to protect themselves as much as possible utilizing guidelines set forth by the Maricopa County Department of Public Health.

COVID-19 (Coronavirus) News

Government Agency Website

Please click on the below government agencies' websites to access the latest news alerts.    

• Arizona Department of Health Services  
• Centers for Disease Control and Prevention (CDC) 
• Centers for Medicare and Medicaid Services (CMS)
• Maricopa County Department of Public Health
• Pima County Department of Public Health
• Pinal County Department of Public Health
• Gila County Department of Public Health

Government Agency FAQ

• AHCCCS FAQ
• CDC FAQ
• ADHS FAQ
• CMS FAQ

 

Events

COVID-19 PRESENTATIONS
You can review previous Mercy Care presentations related to COVID-19.

UPCOMING TRAINING
TAPI TIPS - Training on Immunization Training Series - June 10, 2020 - August 5, 2020 

ONGOING TRAINING

Autism Spectrum Disorder Training for Health Professionals - Ongoing Training 

Arizona's Military Veteran Resource Navigators - AHCCCS Training - Ongoing Training 

Developmental Screening and Fluoride Varnish Training - Ongoing Training

Human Papillomavirus (HPV) Vaccine Safety - Free CME Self-Study Guide - Ongoing through February 25, 2020

What are the Responsibilites of a Medical Provider when Treating Patients who are Deaf or Hard of Hearing?  - Ongoing Training from the Arizona Commission for the Deaf and Hard of Hearing

Newsletters

Mercy Care's Provider Newsletters are published quarterly and provide you with current Mercy Care news that may be important to you: 

2020 Volume 2 Provider Newsletter

2020 Volume 1 Provider Newsletter

2019 Volume 2 Provider Newsletter

2019 Volume 1 Provider Newsletter