For Providers

Mercy Care RBHA Member Handbooks

Proudly Serving Pima County

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.

 

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, our network is evaluated regularly; 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 for review. 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. 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:
  • MercyCareNetworkManagement@MercyCareAZ.Org

 

Practitioners

• AzAHP Practitioner Credentialing Form
• W-9 Form

 

Organizations (Facility/Ancillary)

• AzAHP Organizational Credentialing Form
• AzAHP Facility Application
• W-9 Form

 

Contracting Process

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 representatives are dedicated liaisons who are here to help you. We want you to have a positive experience with Mercy Care.  Your Network Management representative will work closely with you to help you get the most out of doing business with us.  

Network Management representatives offer support such as:

• Site visits
• Training your staff on Mercy Care RBHA policies and procedures
• Providing ongoing education resources such as the provider portal and Provider Manual 
• Resolving operational issues to improve health care delivery
• Being available to answer your questions

Network Management representatives will also help you utilize available technology such as:

• Secure provider web portal
• Health Information Exchange (HIE)
• Administrative functions: Claims submission (EDI), Funds Transfer (EFT), Remittance Advice (ERA)

How to find your Network Management representative

Mercy Care assigns every participating provider a liaison. You and/or your office staff will work with your Network Management representative regularly.  Call the Network Management Department at 800-564-5465 (toll-free) (TDD/TTY) 711 for questions.   

For your convenience, below you can find a listing of your assigned Network Management representative, as well as their detailed contact information: 

• Network Management Assignments - Maricopa County
• Network Management Assignments - ALTCS
• Network Management Assignments - Pima County
• Network Management Assignments - All Other Counties
• Network Management Assignments - Out of State and Non-Contracted
• Network Management - Management