For providers

Prior Authorization Code Changes

Attention providers! Mercy Care has removed hundreds of codes requiring prior authorization from our grids. We did this to reduce some of the administration involved in being part of our provider network.

Prior Authorization Code Changes – FAQ

Mercy Care Prior Authorization Codes

Mercy Care RBHA Prior Authorization Codes

GMH/SU & Non-title Services Prior Authorization Codes

Pima County providers

Mercy Care is proud to continue serving ALTCS, DDD and Mercy Care Advantage (MCA) members in Pima County. Mercy Care is experiencing a high volume of inquiries from members in Pima County who are enrolled in DDD, ALTCS and Mercy Care Advantage (MCA). These members are stating that their providers are informing them of contracting changes related to the AHCCCS Complete Care contract. Please note: the 10/1 changes for the new AHCCCS Complete Care (ACC) program do not impact current DDD, ALTCS and MCA members in any GSA. Mercy Care remains contracted with AHCCCS to provide services to members enrolled in ALTCS, DDD and MCA. If you have any questions please contact your Provider Relations Representative.

Join our network

We are committed to providing quality health care services to our members. And our credentialing and contracting processes help us achieve that goal.

To be eligible to join the Mercy Care and Mercy Care Advantage networks as a provider, you must do the following:

  • 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). Providers joining an existing group must complete the applicable contract documents to be added to the existing contract.
  • 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.

If you have questions about the process, contact your Provider Relations representative at 602-263-3000. 

 

If you are interested in contracting with Mercy Care or Mercy Care Advantage, you must complete the following steps and return appropriate listed application documents: 

A Letter of Interest (LOI) should be faxed to Mercy Care at 1-860-975-3201.  The LOI should be on the provider’s letterhead and must include the following: 

  • AHCCCS ID number
  • Medicare ID number (if applicable)
  • Geographic location
  • Provider specialty and services/facility

Please submit the following forms with your LOI: 

Our Provider Relations department serves as a liaison between Mercy Care and the provider community. Provider Relations 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 Provider Relations 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 Provider Relations 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 Provider Relations representative, as well as their detailed contact information: