MercyCare Health Plans is committed to providing the highest level of care while helping members save on their healthcare costs. Our MyChart allows members to access medical record and health insurance information, helping you manage costs 24/7.
MercyCare members are no longer required to obtain a referral from their primary care physician to see an in-network specialist.
Go to mercycarehealthplans.com to access a provider directory. In the middle of the page click on the box "Find a doctor/facility." Then in the drop-down box, under select your plan, choose "HMO PRIME State of Wisconsin Group Health Insurance Program - W9" and select if you would like to search by practitioner or facility/clinic. Once you are there you can narrow your search if you would like by city, last name, etc. You can also view and print a full directory by clicking here.
Referrals, Authorizations, Out-of-Network
Referrals are not needed when receiving care from in-network providers. Prior authorization is required for certain services, procedures and for out-of-network providers before you receive care. You will receive written notification upon approval or denial for the prior authorization. If you are unsure if a service, test or procedure requires prior authorization or a referral, call 1-800-895-2421, option 5, prior to the appointment.
MercyCare Health Plans recognizes UW Health and University of Wisconsin Hospital and Clinics (UWHC) as a preferred referral center when care cannot be provided by an in-network provider. Prior authorization would be required for any services provided by UWHC
Emergency and Urgent Care
If you require emergency or urgent care when outside of the network, seek care at the nearest medical facility. Contact MercyCare Health Plans at 1-800-895-2421, option 5 within 48 hours of receiving care if possible. Follow-up care must be received from an in-network provider unless otherwise approved by MercyCare Health Plans.
Mental, Behavioral Health and Substance Abuse
No prior authorization or referral is required for outpatient services from an in-network provider. Prior authorization and referral is required for inpatient services and transitional care out-of-network. For other services, contact 1-800-895-2421, option 5.
Healthline: 608-758-5770 or 1-888-756-6060
Major Health Systems
- Mercyhealth Hospital and Trauma Center
- Mercyhealth Walworth Hospital and Medical Center
- Mercyhealth Harvard Hospital and Medical Center
- Mercyhealth Rockton Avenue Hospital
- Mercyhealth Riverside Campus