Provider Manual

The Mercy Maricopa and Mercy Maricopa Advantage Provider Manuals contain important contact information as well as detailed processes and procedures for the care of our members. It also outlines the integration of behavioral health with medical care. 

Compliance with processes and procedures outlined in the Provider Manuals is considered part of your contractual obligation as a participating health care provider.

If you have any questions, please contact your Provider Relations representative.

Mercy Maricopa Provider Manual

Section 1.0:   Scope
Section 2.0:   Introduction
Section 3.1:   Screening for AHCCCS Health Insurance, Medicare Part D Prescription Drug Coverage, and the Limited Income Subsidy Program
Section 3.2:   Appointment Standards and Timeliness of Services
Section 3.3:   Referral and Intake Process
Section 3.4:   Copayments
Section 3.5:   Third Party Liability and Coordination of Benefits
Section 3.6:   Member Handbook
Section 3.8:   Outreach Engagement Re-engagement and Ending an Episode of Care and Disenrollment
Section 3.9:   Assessment and Service Planning
Section 3.10: SMI Eligibility Determination
Section 3.11: Behavioral Health General and Informed Consent to Treatment
Section 3.12: Advance Directives
Section 3.13: Covered Services UPDATE
Section 3.14: Prior Authorization Requirements
Section 3.15: Pharmacy Management NEW
Section 3.16: Behavioral Health Drug List
Section 3.17: Transition of Persons
Section 3.18: Pre-petition Screening Court Ordered Evaluation and Court Ordered Treatment
Section 3.19: Behavioral Health Special Populations
Section 3.20: Credentialing and Re-credentialing
Section 3.22: Behavioral Health Out of State Placements for Children and Young Adults
Section 3.23: Cultural Competence
Section 3.25: Behavioral Health Crisis Intervention Services
Section 3.26: Housing for Individuals Determined to have a Serious Mental Illness
                      Community Living Application
                      Flex Care Supportive Housing Application
                      Transitional Living Program Application
Section 3.27: Verification of Citizenship for Public Behavioral Health
Section 4.1:   Disclosure Health Care Information
Section 4.2:   Medical Record Standards
Section 4.3:   Coordination of Behavioral Health Care with AHCCCS Health Plans, Primary Care Providers, and Medicare Providers
Section 4.4:   Coordination of Behavioral Health Care with Other Governmental Entities
Section 4.5:   Partnerships with Families and Family-Run Organizations in the Children's Behavioral Health System
Section 5.1:   Notice Requirements and Appeal Process for the Title XIX and Title XXI Eligible persons
Section 5.2:   Member Complaints
Section 5.3:   Grievance and Requests for Investigation for SMI Persons
Section 5.4:   Special Assistance for Persons Determined to have a SMI
Section 5.5:   Notice and Appeal Requirements (SMI and non-SMI Title XIX/XXI)
Section 5.6:   Provider Claims Disputes
Section 6.1:   Submitting Tribal Fee for Service Claims to AHCCCS
Section 6.2:   Submitting Claims and Encounters to Mercy Maricopa
Section 7.1:   Fraud and Program Abuse Reporting
Section 7.2:   Medical Institution Reporting of Medicare Part D
Section 7.3:   Seclusion and Restraint Reporting
Section 7.4:   Reporting of Incidents, Accidents and Death
Section 7.5:   Behavioral Health Enrollment, Disenrollment and Other Data Submissions
Section 7.6:   Duty to Report Abuse, Neglect and Exploitation
Section 7.7:   Duty to Warn
Section 7.8:   Reporting Discovered Violations of Immigration Status
Section 8.1:   Encounter Validation Studies
Section 8.3:   Behavioral Health Recipient Satisfaction Survey (Consumer Survey)
Section 8.4:   Performance Improvement Project
Section 9.1:   Training Requirements
Section 9.2:   Peer Support/Recovery Support Training, Certification and Supervision Requirements
Section 10.0: Provider Responsibilities UPDATED 07/31/2014
Section 11.0: Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Program
Section 12.0: Family Planning
Section 13.0: Maternity
Section 14.0: Dental and Vision Services
Section 15.0: Care Management for Serious Mental Illness (SMI) Members
Section 16.0: Medical Management
Section 17.0: Quality Management
Section 18.0: Case Management and Disease Management
Section 19.0: Peer Review
Section 20.0: Provider Deliverables NEW

Mercy Maricopa Advantage Provider Manual

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