DME Provider Network Responsibilities

Applicable to: Mercy Care Advantage, Mercy Care ACC-RBHA, Mercy Care DCS CHP, Mercy Care DD, and Mercy Care Long Term Care

Mercy Care covers reasonable and medically necessary durable medical equipment (DME) when ordered by a primary care provider or a practitioner within certain limits based on member age and eligibility.

As a referring provider for DME services, the provider has the following responsibilities: 

• Confirm that the required service is covered under the member’s benefit plan prior to referring the member.
• Confirm that the receiving provider is contracted with MC.
• Obtain prior authorization for services that require prior authorization or are performed by a non-PHP.
• Complete a Referral Form and mail or fax the referral to the receiving provider.
• Ensure requests from the receiving provider to the referring provider for additional information is responded to timely.

Prior Authorization

Please note Prior authorization is NOT required to refer members to a contracted DME provider. However, certain services may require prior authorization, as indicated in the provider’s contract. Please refer to the Mercy Care Provider Manual for details.

Prior authorization can be obtained by using the following methods:

• Logging on and submitting through Availity
• Request by Phone: 602-263-3000 or 800-624-3879
• Request by Fax: 800-217-9345

AMPM 310-P

Providers are expected to coordinate with Mercy Care on monthly reporting, in order to meet AHCCCS requirements. This reporting measures both Mercy Care’s and vendors’ performance on insuring that the member receives the services timely. Mercy Care requires contracted DME providers to provide order and delivery date for each DME order at least quarterly via the Provider Delivery portal in Availity. Providers must use the standardized DME template to upload the DME order and delivery date. Downloading the latest template from the Provider Data Manager in Availity is the best way of ensuring you are reporting as required. Providers are expected to adhere to the DME delivery timeliness standards listed below: 

Please note:

• If authorization is needed, the TAT starts when the MC gets the PA request.
• If no prior authorization is required, the TAT begins when the order is sent to the DME provider.

Please refer to the following link for the Policy Details : AMPM Policy 310-P

DME Network

Mercy Care maintains a robust network of contracted Durable Medical Equipment (DME) providers available to meet the unique and specific needs of our members.

We understand the difficult part in choosing a DME provider is to know what specific services each may specialize in. For your convenience, here is a list of our contracted DME providers, inclusive of their specialties, to make it easier for you to identify the best provider for our shared members.