August 12, 2019
AzAHP Forms Credentialing Forms

Applicable to: Mercy Care Complete Care, Mercy Care RBHA, Mercy Care Long Term Care, Division of Developmental Disabilities and Mercy Care Advantage
Mercy Care is committed to providing quality health care services to our members. And our credentialing and contracting processes help us achieve that goal.

To be eligible to join the Mercy Care and Mercy Care Advantage networks as a provider, you must do the following:
  • Correctly and completely submit the credentialing application. 
  • Be fully credentialed by Mercy Care or Mercy Care Advantage. 
  • New providers will receive a Participating Health Provider Agreement (contract). Providers joining an existing group must complete the applicable contract documents to be added to the existing contract.
  • Sign and return all contract documents.
  • Upon completion of credentialing and full execution of contract documents, the provider will receive notice from the 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 not schedule or see Mercy Care members until they are notified of the participation effective date.

The following forms must be completed in full and submitted, along with your Letter of Interest (LOI): 

As a reminder, it's important to note that incomplete forms will be rejected by Mercy Care, which may cause unnecessary delays in getting your credentialing approved. 

As always, don't hesitate to contact your Mercy Care Provider Relations Representative with any questions or comments. You can find this notice and all other provider notices on our Mercy Care website. 

Thanks for all you do!