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09/01/2016 Prior Authorization MERCY MARICOPA INTEGRATED CARE LXIX/XXI SMI (MEDICAID) Linear (AZ88) This fax machine is located in a secure location as required by HIPAA regulations. Complete/review

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How to fill out mercy maricopa integrated care

How to fill out Mercy Maricopa Integrated Care:

01

Start by gathering all the necessary information and forms. The Mercy Maricopa Integrated Care application can be found online or obtained through their office. Make sure you have your personal identification, financial information, and any relevant medical history on hand.

02

Read through the application carefully, paying attention to any specific instructions or requirements. It's important to fill out each section accurately and completely to avoid delays or complications in the enrollment process.

03

Begin by providing your personal information, including your name, address, date of birth, and contact information. Double-check for any typos or errors.

04

Next, you may be asked to provide information about your household and income. This can include details about your family members, their relationships, and their sources of income. Be prepared to provide documentation such as pay stubs or tax returns to verify your income.

05

If you have any existing medical conditions or disabilities, you'll likely be asked to provide information about this as well. Be thorough in documenting your medical history and any ongoing treatments or medications.

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As you fill out the application, pay close attention to any checkboxes or options that may apply to your situation. This can include preferences for primary care providers, language preferences, or any specific accommodations needed.

07

Once you have completed all the necessary sections, take the time to review your application for accuracy. Make sure all the information provided is correct and up to date. It may be helpful to have someone else review your application for any potential errors or omissions.

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Finally, submit the completed application either online or in person, depending on the instructions provided. If applying online, make sure to save a copy or print a confirmation for your records.

Who needs Mercy Maricopa Integrated Care?

01

Individuals who have qualifying behavioral health needs may benefit from Mercy Maricopa Integrated Care. This includes individuals with mental health conditions, substance abuse disorders, or a combination of both.

02

Those who are eligible for Medicaid, also known as the Arizona Health Care Cost Containment System (AHCCCS), and reside in Maricopa County are typically eligible for Mercy Maricopa Integrated Care.

03

Mercy Maricopa Integrated Care may also be suitable for individuals who require coordinated care and support services for their behavioral health needs. This can include access to therapists, counselors, psychiatrists, and assistance with medications and treatment plans.

In summary, filling out the Mercy Maricopa Integrated Care application requires careful attention to detail and providing accurate and complete information. It is primarily for individuals with qualifying behavioral health needs who are eligible for Medicaid and reside in Maricopa County.

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What is mercy maricopa integrated care?

Mercy Maricopa Integrated Care is a regional behavioral health authority that manages and coordinates behavioral health services for individuals in Maricopa County, Arizona.

Who is required to file mercy maricopa integrated care?

Providers of behavioral health services in Maricopa County are required to file mercy maricopa integrated care.

How to fill out mercy maricopa integrated care?

Mercy Maricopa Integrated Care can be filled out electronically through their online portal or submitted via mail.

What is the purpose of mercy maricopa integrated care?

The purpose of mercy maricopa integrated care is to ensure the coordination and delivery of quality behavioral health services to individuals in need.

What information must be reported on mercy maricopa integrated care?

Information such as patient demographics, diagnosis, treatment plans, and outcomes must be reported on mercy maricopa integrated care.

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