www.MercyCareAZ.org
January 2, 2020
AzAHP Updated Credentialing Forms
Ap
plicable to: Mercy Care Complete Care, Mercy Care RBHA, Mercy Care Long Term Care, Mercy Care DD and Mercy Care Advantage
AzAHP Credentialing Forms have been updated for 2020 and are now available on our Forms web page. They are also listed below for your convenience:
AzAHP Facility Application
AzAHP Organizational Data Form
AzAHP Practitioner Data Form
If you have any questions regarding the above, please don't hesitate to contact your
Mercy Care Provider Relations Representative
with any questions or comments. You can find this
notice
and all other provider notices on our
Mercy Care
website.
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