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 

If you have questions or concerns, don't hesitate to contact your Mercy Care Provider Relations Representative. You can also reach the Provider Relations Department at 800-564-5465; (TDD/TTY 711).

Proudly Serving Pima County

Mercy Care is proud to continue serving ALTCS, DDD and Mercy Care Advantage (MCA) members in Pima County.

We're 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.

Important 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 questions or concerns, don't hesitate to contact your Mercy Care Provider Relations Representative. You can also reach the Provider Relations Department at 800-564-5465; (TDD/TTY 711).   

Requirements Providers must complete the following steps to be eligible to participate in our network:

  • Credentialing application must be submitted correctly and completely.
  • Providers must be fully credentialed by Mercy Care.
  • New providers will be mailed a Participating Health Provider Agreement (contract). Providers joining an existing group must complete the applicable contract documents in order to be added to the existing contract.
  • Providers must sign and return all contract documents.
  • Upon completion of credentialing and full execution of contract documents, the provider will receive notice from 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 refrain from scheduling and seeing Mercy Care members until notified of the participation effective date.

Should you have any questions regarding the process, you can call your Provider Relations representative.

All providers who are interested in contracting with Mercy Care must fax a Letter of Interest (LOI) to Mercy Care at 860-975-0841. 

The LOI should be on the provider’s letterhead and must include the following information:

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

 Please submit the following forms with your LOI:

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

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

Provider Relations 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

Provider Relations 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 Provider Relations representative

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

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