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  • Prior Authorization Durable Medical Equipment ... - Mercy Care Plan

Get Prior Authorization Durable Medical Equipment ... - Mercy Care Plan

Fax: 1(800) 2179345 Phone: (602) 2633000 18006243879 DME Prior Authorization Standard Request Form Requesting Provider Fax Number: Provider Fax Number: Date of Request: Total Number of pages PLEASE.

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Timely Filing The initial claim must be submitted to AHCCCS within six months of the date of service, even if payment from Medicare or Other Insurance has not been received.

Mercy Care has been serving Medicaid members across Arizona since 1985.

Mercy Care serves AHCCCS members in Maricopa, Pima, Pinal and Gila counties. You have your own health needs. And our health plan is designed to help meet those needs.

Mercy Care is a not-for-profit health plan serving AHCCCS members throughout Arizona. Owned by Dignity Health and Ascension Health, Mercy Care has served Medicaid members since 1985.

To reach Claims Customer Service, please call (602) 417-7670 Option 4.

Mercy Care Member Services representatives are available to help you Monday through Friday, 7 a.m. to 6 p.m. Just call 602-263-3000 or toll-free 1-800-624-3879 (TTY/TDD 711).

Initial Claim: 6 months from the date of service (If HCP is primary, the claim timeliness changes to 7-months from the date of service or eligibility date). Corrected Claim: 12 months from the date of service.

New claim submissions: Claims must be filed on a valid claim form within 150 days from the date services were performed or from the date of eligibility posting, whichever is later, unless there is a contractual exception. For hospital inpatient claims, date of service means the date of discharge of the patient.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232