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  • Az Mercy Care Outpatient Behavioral Health Non-par Provider Initial Single Case Agreement Request 2016

Get Az Mercy Care Outpatient Behavioral Health Non-par Provider Initial Single Case Agreement Request 2016-2025

Means a request for which a provider indicates or a Contractor determines that using the standard time frame could seriously jeopardize the member's life or health or ability to attain, maintain or regain maximum function. The Contractor must make an expedited authorization decision and provide notice as expeditiously as the member's health condition requires no later than three working days following the receipt of the authorization request, with a possible extension of up to 14 days if the me.

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Mercy Care is a local not-for-profit managed care organization. We provide coverage for people who qualify for Arizona Health Care Cost Containment System (AHCCCS) benefits.

Owned by Dignity Health and Ascension Health, Mercy Care has served Medicaid members since 1985. Mercy Care provides access to health care services for families, children, seniors, and people with physical and developmental/cognitive disabilities.

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

Per your contract, we need to receive claims for services you provide our members in a timely manner: New claims: File claims with a valid claim form within 150 days from the date you performed services or from the date of eligibility posting, whichever is later.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
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
Content Takedown Policy
Bug Bounty Program
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:
+1 833 426 79 33
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