We strive to make information readily available to your office. We understand that your office is affected by any changes to the contracts that you hold through Mercy Managed Care. In efforts to keep you updated, this section is designed to update you on contract information including: new contracts, contract terminations, rate updates, TPA changes, and miscellaneous other news.

Please be aware that not all rate changes or contract updates below will necessarily pertain to everyone. We are also not able to publish specific rate information online as that data is confidential. Please see the additional resources below that are available to you to confirm specific contract participation.

  • Mercy Network LLC providers: If you are participating with Mercy via a contract with Mercy Network LLC (this would include providers in Southwest Missouri,  Northwest Arkansas, Oklahoma and select providers in St. Louis), please reference your online matrix for specific contract participation.
  • Mercy PHO providers: If you are contracted with Mercy via the Mercy PHO (this would include the majority of providers in the St. Louis region), please reference your PHO contract and enrollment packet for a listing of the contracts you hold through Mercy.
  • Mercy employed/integrated providers in the St. Louis region: Please continue to reference the Managed Care hub on Baggot Street, and the Sharepoint site as your reference for contract participation.
  • All other Mercy employed/integrated providers: Please continue to use the Managed Care hub on Baggot Street as your reference for contract participation.

Provider Changes
As a contracted provider, it is important to notify us immediately of changes to your practice such as: a new provider joining the practice, changes in billing information, provider leaving the practice, or adding a new clinic location.  Notification may help avoid claim denials.  Please submit changes by fax 417-820-3821 or email. Please include a W-9 Form if the change involves a new billing address or tax identification number.

Managed Care Contract Terminations – December 31, 2017

December 11, 2017

Please be advised that the direct agreements between Mercy and the following companies will terminate effective December 31, 2017.  All three groups will be moving to plans administered by United Healthcare.

  • Arvest Bank
  • Schreiber Foods
  • SMC Packaging Group

Cigna Integrated Oncology Management Program

December 07, 2017

Please review the attached information from Cigna regarding their integrated oncology management program with eviCore.  Effective January 1, 2018, they will add 53 HCPCS codes to the list of medical oncology and oral chemotherapy medications that will require precertification under this program.

Medical Oncology – November 2017 Reminder Provider Letter



Sunflower Health Plan: Planned vs Unplanned Services

December 06, 2017
Planned vs. Unplanned Services for Members in a Psychiatric Residential Treatment Facilities (PRTF)
Effective January 1, 2013, when the primary diagnosis on a claim submitted for medical services is considered “planned” and the member has a level of care (LOC) indicating PRTF, this claim should be submitted to Sunflower for reimbursement.

Claims submitted with the primary diagnosis considered as “unplanned” are not part of the KanCare program and are reimbursed through Fee for Service. Claims for unplanned services will need to be submitted to KMAP for processing and payment.

Medical claims billed to Sunflower in error for unplanned services will deny with a CO 109 – Claim/service not covered by this payer/contractor. The provider must send the claim/service to the correct payer/contractor.


If you have questions about this bulletin or other provider resources, please contact Customer Service at 1-877-644-4623.

Weekly KMAP Roundup Bulletin – December 1

December 06, 2017

Here are this week’s bulletin topics from the Kansas Medical Assistance Program (KMAP). Visit our provider news page to see Sunflower bulletins and other news.

In order to comply with CMS Managed Care Rule 2390, Kansas Medicaid will be making changes to provider enrollment requirements. Effective January 1, 2018, all providers must enroll and obtain a Kansas Medical Assistance Program (KMAP) identification (ID) number prior to contracting with a KanCare managed care organization (MCO). This requirement applies to new providers and existing KanCare providers at the time of re-credentialing. Providers will be unable to re-credential or initiate a new network provider agreement with a KanCare MCO until a KMAP ID number is received. Read more …

Effective with dates of service on and after December 18, 2017, new medications will require prior authorization. Read more …

As outlined in the following bulletins, providers were asked to add or update their current Medicare National Provider Identifier (NPI) with the Kansas Medical Assistance Program (KMAP) so claims automatically crossing over to KMAP from the Centers for Medicare & Medicaid Services (CMS) will process correctly. Read more …

Effective with the processing date of December 1, 2017, retroactive to dates of service on and after October 1, 2017, the Medicare list of unacceptable principal (primary) diagnosis codes has been updated. All affected claims will be reprocessed. The complete Medicare list of unacceptable principal (primary) diagnosis codes can be accessed on the Details for title: FY 2018 Final Rule and Correction Notice Data Files page of the CMS website. Once the page opens, scroll down to the Downloads box and click the Definition of Medicare Code Edits v35 link. Next, open the folder labeled FY2018-CMS-1677-FR-Code-Edits.zip, then open the Definitions of Medicare Code Edits v35.pdf document. Read more …

The Kansas Medical Assistance Program (KMAP) offers an interactive Reference Codes page on the KMAP website. Read more …

Effective with processing dates on and after December 1, 2017, retroactive to dates of service on and after January 3, 2017, for Community Mental Health Centers (CMHCs), H2011HO will be a reimbursable telemedicine code. Read more …


Holiday Check Run Schedule

Cigna Policy Changes – Effective 2/19/2018

November 27, 2017

Effective 2/19/18, Cigna will update seven policies to ensure consistency with CMS guidelines, industry standards, or our existing guidelines. These updates include:


  1. Intraoperative Neurophysiological Monitor (IONM)
  2. Peripheral Nerve Destruction for Pain Conditions
  3. Modifier 62, 66, 80, 81, 82, and AS Assistant Surgeon, Assistant at Surgery, Co-Surgeon (Two Surgeons), and Surgical Team
  4. Global Surgical Package and Related Modifiers (24, 54, 55, 56, 57, 58, 76, 77, 78, and 79)
  5. A4566 Electrodes Per Pair Frequency Limit
  6. Outpatient Clinic Not Covered
  7. Pneumatic Compression Devices and Compression Garments


For additional details about these updates, please review the attached letter/chart.  Also note the policies can be found on the www.cignaforhcp.com under resources and working with Cigna.

November Coverage Policy Updates Provider Letter_Chart MSR 10_11_17 (2) rev 10_26_17 (003)

Weekly KMAP Roundup Bulletin – November 17

November 20, 2017

Here are this week’s bulletin topics from the Kansas Medical Assistance Program (KMAP). Visit our provider news page to see Sunflower bulletins and other news.

Preferred Drug List updates are effective November 1, 2017. Read more …

Effective with dates of service on and after April 1, 2018, Covered Entity pharmacies (excludes contracting pharmacies and physician-administered drugs) that are listed on the Health Resources and Services Administration (HRSA) Medicaid Exclusion File (MEF) and fill Medicaid managed care organization (MCO) member prescriptions with drugs that are purchased at the prices authorized under Section 340B of the Public Health Services Act are required to use a claim modifier to identify 340B claims from non-340B claims. Read more …


December 14: Provider Orientation Webinar. Join us for this valuable training opportunity!

Sunflower November, December, January Holiday Check Schedule

November 20, 2017

Claims Payment Schedule
Due to the shortened work weeks for the Thanksgiving, Christmas, New Year’s and Martin Luther King holidays, Sunflower Health Plan’s check runs will be as follows;

  • Checks issued Tuesday, November 21, 2017 for the week of November 20
  • Checks issued Wednesday December 27, 2017 and Friday December 29, 2017 for the week of December 25
  • Checks issued Wednesday, January 3, 2018 and Friday, January 5, 2018 for the week of January 1
  • Checks issued WednesdayJanuary 17, 2018 and Friday, January 19, 2018 for the week of January 15

USPS Holiday Mail Delays and PaySpan (EFT/ERA)

Due to the holidays and increased USPS mail volume, providers may experience slower than usual receipt of paper checks and remittance advice through USPS.

Sunflower Health Plan is pleased to partner with PaySpan Health to provide an innovative web based solution for Electronic Funds Transfers (EFTs) and Electronic Remittance Advices (ERAs). This service is provided at no cost to providers and allows online enrollment. For more information on this free and easy service, please visit our website at https://www.sunflowerhealthplan.com/providers/resources/electronic-transactions/payspan.html


If you have questions about this bulletin or other provider resources, please contact Customer Service at 1-877-644-4623.


November 17, 2017

Thursday, December 14, 2017

12:00 PM – 1:00 PM

Online only

Mark your calendar for this provider training event!

When? Thursday, December 14, 2017, Noon-1:00 p.m.

What? This course will provide information to attendees on Sunflower’s processes, including but not limited to the following topics:

  • Waste, Fraud and Abuse
  • Web Portal Tools
  • Website Resources and Information
  • Updating Provider and Practitioner Information
  • Connecting with Your Network Specialist
  • Sunflower Partners
  • Covered Benefits and Value Added Services
  • Medical Management and Case Management
  • Claims Submission Guidelines
  • Grievances and Appeals
  • Quality Programs

Why? Sunflower wants all providers in its network to understand how to work with Sunflower

Who? Existing and new providers to the Sunflower network

Where? Online

Please use link above and/or use the call-in number.

If you have questions about this bulletin or other provider resources, please contact Customer Service at 1-877-644-4623.