www.MercyCareAZ.org
July 22, 2021
Prior Authorization Form for Substance Use Residential

Applies to: Mercy Care Complete Care, Mercy Care DD, Mercy Care Long Term Care, Mercy Care RBHA
A new provider form, Prior Authorization Form for Substance Use Residential has been posted to our website on our Forms web page. Please click on the link to view the form in further detail. You must use this form for substance use residential prior authorization requests.

As always, don't hesitate to contact your Mercy Care Network Management Representative with any questions or comments. You can find this notice and all other provider notices on our Mercy Care website.

Thanks for all you do!
www.MercyCareAZ.org