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04/13/2016 Prior Authorization MERCY MARICOPA INTEGRATED CARE - TXIX/XXI SMI MEDICAID AZ88 This fax machine is located in a secure location as required by HIPAA regulations. Complete/review information sign and date. Fax signed forms to Mercy Maricopa Integrated Care - TXIX/XXI SMI at 1-855-247-3677. Please contact Mercy Maricopa Integrated Care - TXIX/XXI SMI at 1-800-564-5465 with questions regarding the Prior Authorization process. Circle Yes or No Y N 2. Does the patient have adequate...
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