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Pharmacy Prior Authorization MERCY CARE PLAN (MEDICAID) EpogenProcrit (Medicaid) This fax machine is located in a secure location as required by HIPAA regulations. Complete/review information, sign.

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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.

Payer Name: Mercy Care Plan (AHCCCS)|Payer ID: 86052|Professional (CMS1500)/Institutional (UB04)[Hospitals]

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.

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.

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

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 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).

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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
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
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