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.

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

KMAP BULLETIN: KDADS AIR SYSTEM
Effective September 1, 2017, the Kansas Department for Aging and Disability Services (KDADS) will implement revised policies and procedures for the use of the adverse incident reporting and management system in accordance with the statutory requirements under 1915 (c) of the Social Security Act and the health and welfare waiver assurance and associated sub-assurances. Read more …

KanCare All-MCO HCBS Trainings start next week! Learn more!

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

KMAP BULLETIN: PRIOR AUTHORIZATION REQUIRED FOR MEDICATIONS
Effective with dates of service on and after September 1, 2017, additional medications will require prior authorization. Read more …

KMAP BULLETIN: KANCARE ALL MCO TRAINING
This will be an all managed care organization (MCO) collaborative session providing training for all providers. In addition to the training, each MCO will be available in breakout sessions all day. Read more …

Join us for our next Orientation/Refresher webinar Friday, Sept. 8!

Please see the following updates from Anthem.

• Hyaluronan injections in the knee
• Remicade agent is preferred product

Anthem Updates 090117

POA Indicator

Effective October 1, 2017, Sunflower will begin rejecting paper UB-04 claims if they are billed with a POA Indicator of 1. This change is to align paper claims with electronic claim processes.

Please leave this field blank when a code is exempt from POA reporting. (The current form code version is 5010.)

A letter will be mailed out if the claim is rejected and will state “POA indicator missing or invalid.”

For more information regarding this change please view: https://www.cms.gov/medicare/medicare-fee-for-service-payment/hospitalacqcond/coding.html

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

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.

KMAP BULLETIN: KEES TRANSITION FOR DCF
The Kansas Department of Health and Environment (KDHE) is currently using the Kansas Eligibility Enforcement System (KEES) to determine eligibility for Medicaid medical services. Our sister agency, the Kansas Department for Children and Families (DCF), will begin using KEES in August 2017 to determine eligibility for non-medical public assistance benefits. During this time of transition, our consumers may experience brief interruptions in benefits processing. Read more …

KMAP BULLETIN: MID-LEVEL PROVIDERS IN CMHCS
Effective with dates of service on and after September 15, 2017, all services performed by a mid-level provider (physician assistant [PA] or advanced practice registered nurse [APRN]), in a Community Mental Health Center (CMHC) are required to have modifier U1 appended to the code(s), with the exception of injections. These claims will be paid at 75%. Read more …

Topics:

• Anthem opioid analgesics utilization management clinical policies
• Company to conduct post-service reviews of MRI’s in the ED
• AIM genetic testing urgent reminder

anthem e-update 081517

Effective July 1, 2017, Anthem Blue Cross Blue Shield will transition the preauthorization reviews for genetic testing to AIM Specialty Health.  The attached letter provides information regarding this change along with instructions on how to register for access to their provider portal.

Anthem – Genetic Testing AIM Notification

Friday, September 8, 2017

12:00 PM – 1:00 PM

Online only

Mark your calendar for this provider training event!

When? Friday, September 8, 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 us

Who? Existing and new providers to the Sunflower network

Where? Online via Skype Meeting

To join the meeting: Join Skype Meeting
Conference Number(s): (314) 512-9400 or (855) 229-5962, Ext 29400
Participant Code: 2185683

Please note: You do not need to have access to Skype to join this meeting. Please use link above and/or use call-in number.

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

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.

KMAP BULLETIN: CODE A9606 NOT CONTENT OF SERVICE
Effective with claims processed on and after September 1, 2017, retroactive to dates of service on and after August 1, 2016, procedure code A9606 will no longer be considered content of service. Retroactive clean-up of claims will not be done. Read more …

KMAP BULLETIN: MEDICARE CROSSOVER CLAIM PROCESSING CHANGES
To comply with the Centers for Medicare & Medicaid Services (CMS) Managed Care regulations at Federal Register § 438.3(t), States that use the automated crossover process must require managed care organizations (MCOs) to enter into a Coordination of Benefits Agreement (COBA) with Medicare and be able to accept and process automated crossover claims. Read more …

REMINDER: We still have availability for our Great Bend Provider Workshop!