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.

Home State Health Provider Notice: Additional Dx. Code Requirement with Autism Spectrum Disorder (F84.0)

November 16, 2018

Please review the attachment and email from Home State Medicaid regarding diagnosis coding for Autism Spectrum Disorder.  Please share this as appropriate.

 Additional diagnosis code requirement with Autism Spectrum Disorder (F84.0) 

 AutismSpectrumDisorderAdditionalDxCode 111618



 As a reminder, Coding and Risk Adjustment Awareness information is housed on their website at :  https://www.homestatehealth.com/providers/tools-resources/coding-page.html



All claim inquiries are to be directed to the Claims Integrity Team with each product having a dedicated team to contact.

Home State Health/Medicaid: 855-694-4663



Home State Medicaid Oxygen Coding Errors

November 16, 2018

Home State Medicaid has identified some common billing errors when coding for oxygen.  They’ve asked that you share this communication with anyone who would be coding this service as a reminder of how it needs to be submitted.





Cigna – Drug Formulary Changes Effective 1/1/2019

October 01, 2018

Please review the attached notice from Cigna regarding changes to their drug formulary effective January 1, 2019.

Please note that Cigna will be sending a letter to all providers who have been identified as having patients who have been prescribed a drug that is affected by the changes.  Also, letters will be sent explaining the drug list changes to the affected patients.

Cigna – Drug Formulary Changes 010119 REVISED

Cigna SureFit Kansas City

September 24, 2018

Beginning October, 1, 2018, Cigna will offer a new plan called Cigna SureFit to employers and their employees in the Kansas City area.  This new plan requires enrolled customers to use only providers who participate in the network aligned to the Cigna SureFit plan, including primary care providers and specialists.  Out-of-network coverage is not available for customers with Cigna SureFit plans, unless it is for a medical emergency.

Since the network for this plan is based in Kansas City, Mercy providers in Southwest Missouri, Arkansas and Kansas will be considered out-of-network for all patients enrolled in this plan.

Please take time to review and share the attached flyer.  The flyer includes sample identification cards to assist with identifying patients enrolled in this plan as well as plan information and a map of the network service area.

Cigna SureFit Kansas City