New Notification of Member in Need of Special Assistance Form
We have recently replaced the old Notification of Member in Need of Special Assistance Form with the updated AHCCCS form that is currently on the AHCCCS website. AHCCCS has informed us that after April 1, 2018, all providers must use the new Notification of Member in Need of Special Assistance Form. They will no longer accept the old form. It is also important to note that you must fill out the Geographic Service Area (GSA) and the RBHA you are serving. The new form has been loaded to our forms webpage as well.
As always, don't hesitate to contact your Mercy Maricopa Provider Relations Representative with any questions or comments. You can find this notice and all other provider notices on our Mercy Maricopa website.
