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.

Arkansas Blue Cross Blue Shield Providers’ News – June 2017

June 02, 2017

Please access the link below to view the June 2017 issue of Providers’ News.

providers news june 2017

Humana 2017 Risk Adjustment Webinar Series

May 31, 2017

Please view the attachment for details on a Risk Adjustment Webinar series offered by Humana with dates throughout 2017.  This will also help your staff obtain MRA education and CEU credits.

Humana 2017 Risk Adjustment Webinar Series

KMAP Weekly Roundup for Kansas Managed Medicaid Plans

May 31, 2017
Weekly KMAP Roundup Bulletin – May 26, 2017
Below is a list of KMAP bulletins that apply to the three KanCare MCOs. Watch for this new Sunflower communication each week. For more news, visit Sunflower’s provider bulletins web page.

KMAP BULLETIN: RATE ADJUSTMENTS

05/26/17

Effective with dates of service on and after June 1, 2017, the Medicaid rates for procedure codes G0202, G0204, and G0206 will be adjusted to reflect the corresponding 70000 range codes (77065, 77066, and 77067).

KMAP BULLETIN: MEDICATION PRIOR AUTHORIZATION

05/26/17

Effective with dates of service on and after July 1, 2017, the following medications will require prior authorization …

KMAP BULLETIN: BILLING FOR CODE 99211

05/18/17

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, bronchiolitis clinic, and other treatments. Reimbursement will be $16.87. The outpatient adjustment factor will not apply.

Missouri Care-Progeny Partnership in Neonatal Care

May 31, 2017

Please view the attached document reviewing the partnership between Missouri Care and Progeny in the management of Neonatal Care.

Missouri Care-Progeny Partnership Letter

Sunflower Provider Orientation-Refresher

May 31, 2017

Mark your calendar for this provider training event.

When? Wednesday, June 14, Noon-1:00 p.m. (CT)

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 via InterCall:

To join the meeting: https://m.iconf.net/nfu6x0z
Conference Number(s): (855) 351-5537
Participant Code: 7595915321

Questions? Please contact 

Sunflower Health Plans: Change to Therapy Pre-Authorizations

May 31, 2017
REMOVAL OF PRIOR AUTHORIZATION REQUIREMENTS FOR SELECT THERAPY SERVICES

What is Changing

To reduce provider administrative burden and ease member access to services, Sunflower Health Plan is revising the requirement for participating (PAR) providers (providers contracted with Sunflower) to obtain a prior authorization for the specific codes listed below for physical, occupational and speech therapy. This activity does not change the benefits or benefit limitations of these services, only the need to authorize these services prior to treatment. Therapy codes not listed below require prior authorization.

Prior authorization is required after the 24th visit per discipline, per year, per member.The first 24 visits for a member’s PT, OT or ST do not require prior auth. Sunflower recommends providers inquire with members about their prior therapy visits for the year before initiating treatment without prior authorization.

Exceptions: Providers not contracted with Sunflower require prior authorization before providing a service/item to a member. Prior auth will still be required for any services rendered in the home setting, Home and Community Based Services (HCBS) and services related to the treatment of autism spectrum disorders as outlined in state guidelines.

These changes are effective on June 1, 2017.

Sunflower will continue to monitor utilization of services and make prior authorization adjustments as indicated, including reinstating prior authorization requirements for members or providers with patterns of not meeting medical necessity on post payment audits.

  • 92507 – TX SPEECH/LANG/VOICE/COMMUN/AUD DISORDER; INDIV
  • 92508 – TX SPEECH/LANG/VOICE/COMMUN/AUD DISORDER; 2/MORE
  • 92526 – TX  swallowing dysfunction and/or oral function for feeding
  • 92613 – FLX ENDO SWALLW CINE/VIDEO;PHYS I&R
  • 92615 – FLX ENDO LARYNG SENSY TST; PHYS I&R
  • 92617 – FLX ENDO SWALLW&LARYNG SENSY;MD I&R
  • 97010 – APPLIC MODAL 1/> AREAS; HOT/COLD PACKS
  • 97012 – APPLIC MODAL 1/> AREAS; TRACTION-MECH
  • 97014 – APPLIC MODAL 1/> AREAS; ELEC STIM
  • 97016 – APPLIC MODAL 1/> AREAS; VASOPNEUMATIC DEVICES
  • 97018 – APPLIC MODAL 1/> AREAS; PARAFFIN BATH
  • 97022 – APPLIC MODAL 1/> AREAS; WHIRLPOOL
  • 97024 – APPLIC MODAL 1/> AREAS; DIATHERMY
  • 97026 – APPLIC MODAL 1/> AREAS; INFRARED
  • 97028 – APPLIC MODAL 1/> AREAS; ULTRAVIOLET
  • 97032 – APPLIC MODAL 1/> AREAS; ELEC STIM EA 15 MIN
  • 97033 – APPLIC MODAL 1/> AREAS; IONTOPHORESIS EA 15 MIN
  • 97034 – APPLIC MODAL 1/> AREAS; CONTRAST BATHS EA 15 MIN
  • 97035 – APPLIC MODAL 1/> AREAS; ULTRASOUND EA 15 MIN
  • 97036 – APPLIC MODAL 1/> AREAS; HUBBARD TANK EA 15 MIN
  • 97039 – UNLIST MODAL (SPECIFY TYPE/TIME-CONSTANT ATTEND)
  • 97110 – THERAP PROC 1/> AREAS EA 15 MIN; EXERCISES
  • 97112 – THERAP PROC 1/> AREAS EA 15 MIN; BALANCE/COORDIN
  • 97113 – THERAP PROC 1/> AREAS EA 15 MIN; AQUATIC THERAP
  • 97116 – THERAP PROC 1/> AREAS EA 15 MIN; GAIT TRAINING
  • 97124 – THERAP PROC 1/> AREAS EA 15 MIN; MASSAGE
  • 97139 – THERAP PROC 1/> AREAS EA 15 MIN; UNLISTED
  • 97140 – MANUAL THERAP TECH-1/> REGIONS-EA 15 MIN
  • 97150 – THERAP PROC(S)-GROUP
  • 97530 – THERAP ACTIVITIES DIRECT PT CONTACT EA 15 MIN
  • 97532 – DEV CONGNITIVE SKILL-1:1-EA 15 MIN 0.68
  • 97533 – SENSRY INTEGRAT TECH-1:1-EA 15 MIN 0.74
  • 97535 – SELF CARE/HOME MGMT TRAIN-1 ON 1-EA 15 MIN
  • 97537 – COMMUNITY TRAIN-1 ON 1-EA 15 MIN
  • 97542 – WHEELCHAIR MGMT/PROPULSION TRAIN-EA 15 MIN
  • 97545 – WORK HARDENING/CONDITIONING; INIT 2 HR
  • 97546 – WORK HARDENING/CONDITIONING; EA ADD HR
  • 97760 – ORTHOTIC MGMT&TRAINJ UXTR LXTR&/TRNK EA 15 MIN
  • 97761 – PROSTC TRAINJ UPR&/LXTR EA 15 MIN
  • 97762 – CHECKOUT F/ORTHOTIC/PROSTC USE EST PT EA 15 MIN

For questions or concerns

The prior authorization code checker will be updated accordingly by June 1, 2017, with these changes.

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

Cigna – August 2017 Coverage Policy Updates

May 30, 2017

Please see the attached notice from Cigna regarding coverage policy updates going into effect in August of 2017.

Cigna – August 2017 Policy Updates

Cigna – Standard of care and utilization management for pediatric cancer treatment

May 17, 2017

Please review the attached notice from Cigna regarding pediatric cancer treatment and changes that will take place on June 26, 2017.

Cigna – Pediatric Cancer Treatment 050517