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09/09/2015 Prior Authorization MERCY MARICOPA INTEGRATED CARE - TXIX/XXI SMI MEDICAID Brand Name Behavioral Health Medications AZ88 This fax machine is located in a secure location as required by HIPAA regulations. 11. Has the prescriber evaluated and determined that medication non-adherence is not the reason for the dose escalation 12. 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...
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