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.

Aetna Officelink Updates June 2018

Please see the following correction from Aetna:

Correction: Wrong date listed in June provider newsletter

A June 2018 Aetna OfficeLink Updates™ (OLU) article stated the wrong date. The article telling providers that precertification is no longer required for home health care services for Medicare Advantage members incorrectly said the change would take effect July 1, 2018. The correct date is June 1, 2018.

To confirm, effective June 1, 2018, precertification is no longer required for the following home health care services for Medicare Advantage members:

• Home dialysis
• Home health aide or certified nursing assistant
• Home infusion/injectable therapy
• Home nursing care by registered or licensed nurse
• Home physical/occupational, respiratory and speech therapy

Private duty nursing still requires precertification.

This attachment contains information relating to Dental Surgery and the use of D7999 as well as prior authorization requirements for Spinal Surgery Codes.  These changes apply to Home State Managed Medicaid.

Dental Surgery Coding and Spinal Surgery Prior Authorization Update

Please review the attached update from Cigna regarding a change in their drug formulary for Copaxone.

cigna drug formulary update 070118

• New feature allows members to pay providers at anthem.com
• IN, KY, MO, OH: Claims requiring additional documentation
• KY, MO, WI: Clarification of Multiple Diagnostic Imaging reimbursement policy

Anthem e-update 050118

Click on the link below to view the April edition of Cigna Network News.

Cigna Network News April 2018

Please review and share the attached Cigna policy updates.

cigna policy update effective 070118

cigna policy update effective 071518

2018 Cigna ID Cards

Please review the attachment and information below regarding changes to the Humana Medicare pre-authorization list.

There are currently two sets of authorization lists in place for Humana Medicare patients-one published by Humana and one by Mercy.

Effective May 1^st, 2018 the Mercy-published authorization list will be going away and all providers and facilities will be required to follow the Humana-published list.

The attachment provides additional information as well as a list of codes that previously did not require authorization by Mercy Care Management, but beginning 05/01/2018 will require pre-authorization.  There is also a link to the full Humana authorization list on the attachment.

Humana Updated Medicare Pre-Auth List

Anthem Network Update April 2018 (2)

Please see attached letter from Cigna regarding changes to their drug formulary going into effective on July 1, 2018.

Cigna – Drug Formulary Changes 070118 (2)