Mercy Care: The Inside Scoop

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April 29, 2026

Correction: Links fixed for AHCCCS system updates (last article)

Join us for our upcoming webinars & events

It is not too late to register for today's webinar

Disability Benefits 101 (DB101)

Focusing on the benefits‑planning tool DB101. This online tool provides resources and education on the impact of income from employment on Social Security benefits. April 29, 2026 from noon to 12:30 pm. Register here.

2026 Arizona Healthcare Workforce Goals and Metrics Assessment

Q&A session where we will address questions regarding the 2026 AHWGMA - April 30, 2026 from 2:30 pm to 3:00 pm. Register here.

RSA/Vocational Rehabilitation (VR)

Focusing on the Vocational Rehabilitation program, which provides a variety of services to people with disabilities to help them prepare for, enter or retain employment. May 6, 2026 from noon to 12:30 pm. Register here.

Mercy Care in-person provider forum General program updates, followed by remarks from AHCCCS, DDD, and DCS CHP leadership. Key priority areas: Gaps in care, HEDIS/Stars, health literacy, therapeutic foster care, workforce development initiatives. In Flagstaff, Arizona 9:00 am - 4:00 pm May 14, 2026. Register here.

Availity

Gaps in Care Manual

HEDIS

Model of Care Training

Sonora Quest Lab Locations

Friendly reminders

Take the 2026 Mercy Care Provider Survey by July 31, 2026.

AHCCCS solutions center webinar

*Additional session added

AHCCCS is launching the AHCCCS Solutions Center, a new platform to streamline provider communication and request submissions.

Providers and office staff
Thursday, April 30, 2026
From 3 to 4 pm

Seclusion and restraint reporting updates

Mercy Care will implement a new Seclusion and Restraint Reporting (SAR) Timeliness Oversight Framework effective June 1, 2026, to reinforce compliance with the five‑business‑day reporting requirement by AHCCCS AMPM 962. The updated process monitors SAR submissions over a rolling ninety‑day period and applies graduate oversight, ranging from routine monitoring to formal improvement plans and executive review for repeated or significant noncompliance. Providers are encouraged to review internal workflows to ensure timely and consistent reporting.

Read provider letter here.

Reminder to providers: required prenatal and delivery syphilis testing

Maricopa County Department of Public Health issued a notice to healthcare providers extending its prenatal and obstetrical syphilis prevention policy through Dec. 31, 2026, in response to rising congenital syphilis cases. The order requests third‑trimester syphilis screening (optimally at 28–32 weeks), requires syphilis testing at delivery for all newborns or their mothers, and mandates testing in cases of stillbirth at 20 weeks’ gestation or later, consistent with Arizona statutes. Providers are also reminded of the requirement for syphilis testing at the first prenatal visit. To support public health surveillance, hospitals are asked to submit monthly reports detailing total births, births with maternal syphilis testing, and births involving syphilis‑positive mothers. Visit Maricopa County web page for additional information.

Virtual lunch and learn unlocking educational opportunities

The Division of Developmental Disabilities is hosting a virtual Lunch and Learn for behavioral health providers focused on employment supports available through state systems.

Unlocking Opportunity: Navigating Employment Systems of Work for You will review how state services work together to support employment pathways. The session will feature the Arizona Employment First team.

When: Tuesday, May 20, 2026, from noon to 1 pm

Who should attend: Behavioral health providers

Space is limited. For more information, visit the DES Behavioral Health Training Opportunities webpage.

Billing and time documentation reminders for case management services

The AHCCCS Covered Behavioral Health Services Guide outlines important billing and documentation requirements for case management (T1016) and behavioral health outreach (H0023). Mercy Care would like to remind providers about the appropriate usage of these services and the billing requirements around these services.

Click here to review requirements.

Remote Patient Monitoring (RPM) documentation: What to know

A recent review of RPM documentation for CPT codes 99091, 99453, 99454, 99457, and 99458 identified common opportunities for improvement across providers. Documentation frequently lacked clear support for medical necessity, cumulative time requirements, interactive communication, device use and data transmission, patient education, consent, and distinction from other care management services. This educational communication reinforces the importance of complete, accurate documentation to ensure RPM services billed are fully supported and compliant.

ACOM Policy Update Available

Updates to the AHCCCS Contractor Operations Manual are now available on the AHCCCS website.

ACOM Policy 444, addressing notice and appeal requirements for serious mental illness appeals, was revised to reflect changes to applicability, SMI eligibility, and informal conference scheduling.

Several attachments were also updated to revise appeal acknowledgment language, contact information and form options.

For a complete list of updates, see the March 17, 2026, ACOM Revision Memo on the AHCCCS website.