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 following announcement was received from Cigna regarding a change in the administration of the health insurance plan for State of Illinois employees.  We are not sure what, if any, volume we have in Southwest Missouri.  However, we wanted to pass this information along in case any of these patients present for care at our hospitals or clinics.

State of Illinois: Client transition to a new payer

Effective July 1, 2017, Cigna will no longer administer health insurance coverage for State of Illinois employees. Aetna will replace Cigna as the administrator for the State of Illinois self-funded health care plans. 

 The State of Illinois is a large Administrative Services Only (ASO) client with 70,000 covered individuals who currently access Cigna's Open Access Plans® (OAP) network. Cigna has served as the administrator for State of Illinois self-funded health care plans for 15+ years. 

Cigna will continue to process claims for dates of service prior to July 1, 2017, through a run-out period of 12 months following the termination date (until June 30, 2018). However, providers will continue to experience a delay in claim payment due to the lack of a State of Illinois budget. 

Termination of Cigna's relationship with the State will not affect customer’s benefits payable under the plan(s) through June 30, 2017.

Effective July 1, 2017, HealthChoice is updating the certification requirements to include all CT scans, MRIs, MRAs, PETC, SPECT, and outpatient pacemaker/defibrillator procedures. To see a complete list of CPT/HCPC codes that HealthChoice is adding to the certification list, please visit our website at https://www.ok.gov/sib/Providers/HealthChoice_Certifications.html.

Please review the attached information from Cigna regarding their Integrated Oncology Management Program administered through eviCore healthcare.

Cigna – Integrated Oncology Management Program (2)

Please review the attached information from Cigna regarding changes in their coverage policy for Opioids effective July 1, 2017.

Cigna – Opioid Coverage Changes (2)

Please review the attachment regarding a Chronic Disease Self-Management Program starting on June 19^th.  This is geared towards any provider who has patients with chronic conditions and that would like to improve their quality of life.  Please forward this to any of your offices that you feel would benefit from this information.

We ask that you encourage participation since, as of now, these classes are in danger of being cancelled if attendance doesn’t increase.  Attendance is free due to a grant from the Missouri Department of Health

CDSMP Class

Here are this week’s KMAP bulletin topics. Please click to read more. Visit our provider news page to see Sunflower bulletins and other news.

KMAP BULLETIN: NCCI MUE QUARTERLY UPDATES

06/02/17 

Effective with dates of service on and after July 1, 2017, additions, revisions, and deletions related to third quarter National Correct Coding Initiative (NCCI) and Medically Unlikely Edits (MUEs) will be made according to the Medicaid quarterly files. Reference the Centers for Medicare & Medicaid Services (CMS) website for additional information.

KMAP BULLETIN: MCO PROVIDER APPEAL PROCESS

06/01/17 

Effective with payment denials processed on and after May 1, 2017, the three KanCare managed care organizations (MCOs) standardized the Provider Appeal process for all KanCare providers. Providers continue to have the opportunity to dispute a denial of payment, in whole or in part, from an MCO by submitting a Reconsideration request or an Appeal request or both to the MCO.