Mercy Care Provider Newsletter

Since the start of the COVID-19 pandemic, AHCCCS employed “continuous enrollment” per federal direction. As a condition of receiving enhanced federal funding, AHCCCS could not take any negative actions during a member's annual renewal of eligibility. No one who was enrolled in Medicaid during this time lost their Medicaid coverage (unless they moved out of state, voluntarily disenrolled, aged out of KidsCare, or passed away).

Medicaid enrollment has increased by 33% in Arizona since the start of the pandemic. Due to federal legislation passed in December 2022, the continuous enrollment requirement is no longer tied to the public health emergency end date, and AHCCCS is required to begin the disenrollment process starting April 1, 2023.

AHCCCS will redetermine all members, over 12 months, using a hybrid approach of “ineligible” before “nonresponsive,” oldest application date to newest, and will align households when possible.

AHCCCS and Mercy Care will closely monitor the renewal progress during the 12 months and:

Share renewal update files; and
Communicate publicly about how to connect individuals to coverage.

Medicaid members can ensure continuous coverage by:

Updating their contact information in www.healthearizonaplus.gov.
Checking their mailbox for renewal information.
Responding to AHCCCS to complete their renewal.
If health insurance is needed, they may call 2-1-1 or go to www.211.org

ProPat reminder

Our On-Line Prior Authorization Search Tool (ProPat) is now available on our website with no log-in. Locations are as follows:

Mercy Care Complete Care

Mercy Care RBHA

Mercy Care Long Term Care

Mercy Care DD

Mercy Care Advantage

Provider Survey for 2023

Mercy Care’s Provider Survey was sent to random contracted providers in February 2023. If you received a Provider Survey, we encourage you to complete and submit it as soon as possible. Your candid opinions provide us with valuable feedback on how we can improve our service to you.

Dual Eligible Special Needs Plan Model of Care (MOC) Training

The Model of Care provides the basic framework for which a Special Needs Plan will meet the needs of its enrollees. Under our Medicare contract, Mercy Care Advantage (MCA) is required to implement a Model of Care and must provide routine training to health plan staff and network providers who contribute to the effectiveness of the Model of Care requirements. The MCA Model of Care training provides education on the MOC elements and goals established by the health plan and the role that our network providers play in its delivery to members.

Network providers are required to complete MCA Model of Care Training within 90 days of contracting and annually thereafter.

Network providers can access the MCA MOC training and attestation via the Mercy Care Provider website at Mercy Care Model of Care Training. The training includes an attestation that must be completed by network providers. In addition, Network Management Representatives are able to provide a copy of the MCA MOC training to network providers who prefer to conduct in office training for their staff. Network Management Representatives monitor timely MOC training completion and will follow up with network providers as required to comply with this MCA contract requirement.

Advancing American kidney health

According to the Federal Register, Volume 84, No. 135, July 15, 2019, Executive Order 13879 concerns Advancing American Kidney Health.

Mercy Care would like to share this Executive Order with our provider network, which highlights the need to improve the use of home dialysis and kidney transplants.

The Executive Order states: “The state of care for patients with chronic kidney disease and end-stage renal disease (ESRD) is unacceptable: too many at-risk patients progress to late-stage kidney failure; the mortality rate is too high; current treatment options are expensive and do not produce an acceptable quality of life; and there are not enough kidneys donated to meet the current demand for transplants.

Kidney disease was the ninth-leading cause of death in the United States in 2017.

Approximately 37 million Americans have chronic kidney disease, and more than 726,000 have ESRD. More than 100,000 Americans begin dialysis each year to treat ESRD. Twenty percent die within a year; fifty percent die within five years. Nearly 100,000 Americans are currently on the waiting list to receive a kidney transplant.

An Awareness Initiative has been implemented regarding Kidney and Related Diseases.

This Awareness Initiative will educate patients and support programs that promote kidney disease awareness.

The initiative shall help to develop proposals to support research regarding preventing, treating, and slowing the progression of kidney disease; to improve kidney transplantation; and to share information with patients and providers to enhance awareness of the causes and consequences of kidney disease.

One aspect of improving the care for these members concerns home dialysis and transplantation. Greater rates of home dialysis and transplantation will improve quality of life and care for patients who require dialysis and may eliminate the need for dialysis altogether for many patients.

Provider web portal

As of January 2023, Mercy Care has teamed up with Availity to enhance your portal needs and make it easier to utilize our online tools.

On the Availity portal for Mercy Care providers, you can use:

Payer Spaces
Claims Submissions Link (Change HealthCare)
Eligibility and Benefits
Enhanced Panel Roster.
Claims status inquiry.
Provider Intake (i.e., ALTCS Referrals, Member Paneling, Crisis/State-Only Membership).
Grievance and Appeals - grievance submission, appeal submission, and grievance and appeal status.
Panel Roster - Panel lookup.
Reports - PDM/ProReports (Provider Deliverable Manager) and ambient (business intelligence reporting).
Prior Authorization - Submission and status lookup.

To find information and training about our new Availity Provider Portal, visit the Availity landing page at:

Availity Provider Portal

Availity registration

If you are already registered in Availity, select Mercy Care from your list of payers to start using the available tools and features.

If you are not yet registered go to:

Availity Provider Registration

For registration assistance, please call Availity Client Services at

1-800-282-4548 between the hours of 8 a.m. - 8 p.m. EST, Monday - Friday (excluding holidays).

Mercy Care will be retiring the current Medicaid Provider Portal in late 2023. Effective February 23, 2023, Mercy Care will no longer accept Medicaid Provider Portal requests.

As always, don't hesitate to contact Customer Service at 1-602-263-3000 with any questions or comments or visit us on our Mercy Care website at www.mercycareaz.org.

As part of Mercy Care’s comprehensive communication strategy, we use Constant Contact, an email marketing vendor, to assist us in getting important information directly to our providers via e-mail.

We continue to post all provider communications to our website -- the email process doesn’t take the place of this. While we currently have acquired several provider emails, we know we don’t have them all.

If you’re interested in receiving communication from us via email, we encourage you to sign up for Constant Contact. Providers can register to receive updates by clicking on the link and completing the request. If you have any questions, you may contact Network Management at mercycarenetworkmanagement@mercycareaz.org.