Mercy Care Advantage
Fast, Easy Answers to Your Questions
Mercy Care’s new Interactive Voice Response, or IVR, system, makes it easy to get member and claims information 24/7. You can:
- Access member benefits and eligibility information
- Get answers to Frequently Asked Questions ‑ such as appeals address, payer ID, etc.
- Obtain claim status at header level
- Obtain claim status at line level
- Obtain amount paid on a specific claim
- Request single claim information by fax
Find out more about IVR.
Join our network
We appreciate your interest in joining Mercy Care’s network. We are committed to providing quality medical and behavioral health care services to our members. Mercy Care’s network is closed to most medical and behavioral health care providers. Currently, our network meets the needs of our membership and our letter of interest, contracting and credentialing processes help us achieve that goal. While Mercy Care maintains a robust, well established network of physical and behavioral health providers, we are committed to the ongoing diversification of services available to members in our six lines of business. Specifically, we are actively recruiting for both Behavioral Health/Physical Health services that are specifically developed to meet the unique needs of our members, including but not limited to, those with a focused approach on LGBTQ services, services delivered in languages other than English, services designed to meet the unique cultural needs of our members, and specific specialty services in more rural parts of the state, such as behavioral health outpatient services and cardiology services for children and adults. If you believe your organization may able to deliver additional value to the members we serve, we would love to hear from you. Below is the process for submitting your letter of interest for network participation consideration.
AHCCCS (Arizona Health Care Cost Containment System) is Arizona’s Medicaid Managed Care Program. Mercy Care is contracted with AHCCCS to provide Medicaid covered benefits and services to Mercy Care members. Providers must register with the AHCCCS program to be eligible for payment reimbursement. Registered providers agree to abide by state laws and agree to accept the state Medicaid payment as payment in full. Arizona state law and your Mercy Care provider contract prohibits balance billing MC members for Medicaid covered services and benefits.
Letter of Interest process
Mercy Care’s network is closed to most medical and behavioral health care providers. Currently, our network meets the needs of our membership. However, as noted previously, our network is evaluated regularly and the needs of our members remain at the forefront of our overall network management. If it is determined the network need has changed and services provided by your organization are warranted, a Network Management Representative will contact you directly. You may submit a potential future provider letter of interest and W-9 Form for review. If your request for network participation is denied, please be advised that an additional request received within one year from the date of this letter of interest will be considered a duplicate and will receive an automatic “No Thank you” response. Additionally, specialty Behavioral Health providers should include a summary description of programs, including target populations and age categories, specific models of care/therapies used, along with frequency of programming treatment.
Credentialing process- to be completed only after Letter of Interest approval
Mercy Care is a member of the Arizona Association of Health Plans (AzAHP) and participates in the AzAHP Credentialing Alliance whose aim is to make the credentialing and recredentialing process easier by eliminating duplication of efforts and reducing administrative burden.
The Credentialing Alliance's streamlined process utilizes the Council for Affordable Quality Healthcare (CAQH) Universal Provider Datasource for all practitioner credentialing applications for all participating plans and a common paper application for all facility credentialing applications. The Credentialing Alliance also uses a common practitioner data form and organizational data form to collect information necessary for their contract review process and system loading requirements.
The Credentialing Alliance uses Aperture Credentialing for primary source verification (PSV) services for the alliance. Aperture performs the PSV once and shares the results with each participating plan that you authorize to receive it.
Practitioners Only - go to https://proview.caqh.org/Login to complete or update your CAQH application with the following information:
- The location where you primarily practice
- Primary credentialing contact information (name, address, phone, etc.)
- Updated attestation
- DEA license, state medical license, malpractice insurance certificate, proof of board certification or upcoming exam (if applicable), CMEs for prior three (3) years (if not board-certified)
- Malpractice claims history
- Physician Assistants (PA’s) only- upload a current copy of the delegated agreement with the supervising physician and your scope of practice to your CAQH application.
- Additional details related to the Credentialing Alliance and some of the benefits you will see from it are listed below:,
- A single date that allows one recredentialing process to satisfy the recredentialing requirement for each of the participating plans with which you contract. That date is the earliest date you are set to be recredentialed by any of the participating plans. Following the initial alliance recredentialing event, your next recredentialing date will be set three (3) years out.
- For practitioner groups that are adding a new practitioner, you simply complete the common Practitioner Data Form once and send to each of the participating plans your group is contracted with. Practitioners must also make sure CAQH is updated and each of the participating plans that you are contracted with are approved to access your CAQH application. Please remember that adequately completing your CAQH application will help reduce credentialing timelines. Be sure to upload all supporting documents and that re-attestation is required every 120 days (reminders are sent out in the form of an email prior to expiration).
- If you are a new practitioner, ancillary or facility, complete the appropriate common data form (Practitioner or Organizational) once and send to the participating plan(s) you wish to contract with. Facility/ancillary providers must also complete the common facility application.
- If you are a practitioner that requires a site visit as part of the initial credentialing event (Primary Care Provider or Obstetrician) or a facility that requires a site visit as part of the initial credentialing event (facilities that are not accredited or surveyed), the participating plan(s) that you are requesting to contract with will have access to any site visit already performed under the alliance. If a site visit has already been performed by another participating plan in the Credentialing Alliance, another site visit will not be necessary. If no site visit has been performed by a participating plan in the AzAHP credentialing alliance, a single site visit will be performed as part of the initial credentialing event and made available to all participating plans.
- Please complete the applicable form(s) below and email the completed form(s) and attachments to our Network Management Team at:
To be eligible to join the Mercy Care and Mercy Care Advantage networks as a contracted provider, you must do the following:
- Submit a potential provider Letter of Interest following the process outlined;
- Be directly contacted by a Network Management Representative with an approved Letter of Interest to join our network;
- Correctly and completely submit the credentialing application;
- Be fully credentialed by Mercy Care or Mercy Care Advantage;
- New providers will receive a Participating Health Provider Agreement (contract); and
- Sign and return all contract documents.
Upon completion of credentialing and full execution of contract documents, the provider will receive notice from the Mercy Care Network Development department with the effective date of participation, along with the fully executed contract (if it is a new contract).
Providers should not schedule or see Mercy Care members until they are notified of the participation effective date.
New providers receive written confirmation of their effective date with the health plan. Members may not be seen until the provider receives written confirmation that a request or change is approved and completed (this includes approval by the Credentialing Committee and signed contract, if applicable).
Refer to our Provider Manual for more detailed information. Contracted providers can find reimbursement information in their Mercy Care contracts. Non-contracted providers can refer to the AHCCCS fee schedule for reimbursement information.
Network Management Department
Our Network Management department serves as a liaison between Mercy Care Advantage and the provider community. Network Management is responsible for training, maintaining and strengthening the provider network in accordance with regulations.
If you need to check on the status of a claim, please use our secure web portal. You may access the portal by clicking on the link in the top upper right hand corner of this web page under Find A Provider. You must be a registered user to access it. To register, please fill out our Registration Form. Please fax to the below number to start the process.
If you have questions regarding a processed claim, either paid or denied, please feel free to contact our Customer Service department at 602-263-3000 or 800-624-3879, Express Service Code 626. Non-participating providers should contact our Customer Service department for all issues, in addition to claims issues.
You can fax directly to Provider Relations at 860-975-3201 the following information:
- Notifying the plan of changes to your practice
- Tax ID changes
- Recent practice or provider updates
- Termination from practice
- Web Portal Registration Form
Please feel free to contact our Network Management department for the following:
- Questions regarding the web portal Registration Form or to check on enrollment status
- Credentialing requirements
- Provider Education
You can reach our Network Management department by calling 602-263-3000 or 1-800-624-3879, Express Service Code 631.
For your convenience, below you can find a listing of your assigned Network Management representative, as well as their detailed contact information:
Quarterly PCP Visits
Our Network Management representatives visit provider offices every quarter. Contact your Network Management representative to schedule an appointment, or to learn when your representative will visit your office.
Mercy Care Advantage Model of Care Training
The Model of Care (MOC) for the MCA Special Needs Plan (SNP) offers an integrated care management program with enhanced assessment and management for enrolled dual eligible enrollees. The processes, oversight committees, provider management, care management, and coordination efforts applied to address enrollee needs result in a comprehensive and integrated model of care.Under our Medicare contract, MCA is required to implement a MOC and must provide ongoing training to health plan staff and network providers who contribute to the effectiveness of the MOC. The MCA MOC training provides education on the elements and goals established by the health plan and the role that our network providers play in its delivery to members.Network providers are required to complete the MOC Training within 90 days of contracting and annually thereafter. The training includes an attestation that must be completed by network providers. In addition, Network Management Representatives are able to provide a copy of the MCA MOC training to network providers who prefer to conduct in office or virtual training for their staff. Network Management Representatives monitor timely MOC training completion and will follow up with network providers as required to comply with this MCA contract requirement.
Additional information about Mercy Care Advantage