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.

The Summer 2017 edition of the Provider Report newsletter is now available.

In this issue, you can read about:

• Quality initiatives;
• Well-child checkups and healthy teens;
• Appointment availability and access standards; and
• more

The Provider Report and other helpful resources can be found at www.sunflowerhealthplan.com/providers/resources.html

Republished with permission from the Immunize Kansas Coalition

Less than 64 percent of Kansas adolescents are covered by meningococcal vaccination. Meningococcal disease is caused by bacteria that can cause infections in the bloodstream or infections in the brain and spinal cord. Meningococcal disease is severe and can kill a person within 24 hours after the appearance of the first symptoms. One in every ten cases of meningococcal disease is fatal, and two in the surviving nine will suffer from lifelong disabilities.

In response to Kansas having some of the lowest adolescent vaccine rates in the country, the Immunize Kansas Coalition (IKC) made increasing adolescent vaccine rates a priority, specifically HPV and meningococcal vaccine rates. The IKC has set goals of increasing the adolescent meningococcal conjugate vaccine rate (Men A,C,W,Y rate) from 64% to 80% by 2020. To help achieve these goals, the IKC released a Call to Change, which encourages health providers, parents, and community members to work together on increasing vaccination to protect our kids against meningococcal disease.

The Call to Change is the lead document in IKC’s Meningococcal Vaccine Toolkit. The toolkit compiles some of the best resources in Kansas and across the country for helping providers increase their vaccination rates. The toolkit’s release was unveiled by IKC Chair Hope Krebill at the Kansas Immunization Conference.

Continuing to promote HPV vaccinations, IKC launched Community HPV Education Events toolkit. This toolkit provides resources for communities who are looking to host their own event to increase HPV awareness and spur action to improving HPV vaccination rates. The key tool for hosting these events is the “Someone You Love” video. It is a documentary sharing the stories of five women who are fighting against cervical cancer, which is generally caused by HPV.

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: UPDATED BILLING FOR CODE 99211
Effective with dates of service on and after July 1, 2017, hospitals can bill procedure code 99211 for registered nurse (RN) services and costs associated with the use of the room and supplies when no other professional service is reimbursable. This includes, but is not limited to, wound care, obstetrical check, and other treatments. Read more …

KMAP BULLETIN: HCBS I/DD SUPPORTIVE HOME CARE
Supportive Home Care (SHC) services continue to be available through the Home and Community Based Services (HCBS) Intellectual/Developmentally Disabled (I/DD) waiver. Reference the updated HCBS Intellectual/Developmentally Disabled Fee-for-Service Provider Manual on the Provider Manuals page of the Kansas Medical Assistance Program website for specific information on coverage, benefits, and limitations. Read more …

KMAP BULLETIN: BUDGET REDUCTION RESTORATION
Effective with the processing date of July 28, 2017, retroactive to dates of service on and after July 1, 2017 (or discharge dates on and after July 1, 2017, for inpatient claims), the provider payment reductions that were implemented on July 1, 2016, will be restored, with the exception of the Health Care Access Improvement Program (HCAIP) enhanced payment rate for hospital inpatient claims for in-state hospitals. The HCAIP enhanced payment rate for inpatient claims will continue to receive the 2.14% reduction, which is taken off of the base DRG payment. Read more …

KMAP BULLETIN: HCPCS JULY 2017 UPDATES
Effective with dates of service on or after July 1, 2017, additional procedure codes will be covered. Read more …

Check out our Provider Training Resources!

Please click the following link to access an outline of recent changes Anthem BCBS has made to their Medical Reimubursement Policies.

http://view.messageinsite.com/?qs=13e16acfc74573e2c7a01fe2fc0c15573505a8fe9410100d1007004b2fbf8a6140a271d1dd14a14e5960659cde160db1a6c93c6042d0196c6f9be31d9bb45c60fb3b9220fadcd162

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.

Next Week: Due to the July Fourth holiday work week, Sunflower Health Plan will distribute provider checks and EFT on Friday, July 7 only.

KMAP BULLETIN: PRTF ADMISSION ASSESSMENT
In accordance with a directive received from the Centers for Medicare & Medicaid Services (CMS), the pre-admission screening process is no longer allowed (using T1023). Read more …

KMAP BULLETIN: WHEELCHAIR SEATING ASSESSMENTS
Effective with the implementation date of August 1, 2017, and retroactive to dates of service on and after July 1, 2017, Physical Medicine and Rehabilitation procedure codes 97542, 97755 and 97760 will be covered as medically necessary for management of wheelchair seating assessments for all Medicaid beneficiaries. Regardless of provider, reimbursement will not exceed $500 per beneficiary per year for seating assessment services. Read more …

Please see the attached quick reference guide regarding Cigna’s Radiation Therapy Program through eviCore.

Cigna – Radiation Therapy QRG

Effective July 1, 2017, HealthChoice will be changing the benefits on selected DME items.  Please click the following link for more information on these changes.

HealthChoice DME Benefit Changes for July 1