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.

Allwell, Ambetter, and Home State Health: Payment Policies effective 6/1/18

March 23, 2018

Please review the attached policy updates for patients enrolled in the Allwell, Ambetter and Home State Health plans.  These updates will go into effective June 1, 2018.

Payment Policy Updates Effective 060118 FINAL (2)

 

Cigna Policy Updates – June, 2018

March 21, 2018

Please review the attached letter from Cigna regarding their policy updates for June of 2018.

Cigna Policy Updates – June, 2018

 

Home State Health-Lead Case Management

March 01, 2018

Please review the attached document regarding Lead Case Management Updates from Home State Health.

Lead Case Management

 

Cigna Reimbursement Policy Updates – 5/19/2018

February 19, 2018

Effective May 19, 2018, they will update the following reimbursement policies:

  • Facility Routine Services, Supplies and Equipment (R12)
  • Pharmacy and Infusion Services (R14)

cigna reimbursment policy update 051918

Allwell from Home State Health – Referral Requirements

February 15, 2018

Effective April 1, 2018, Allwell from Home State Health will begin requiring an active referral from the patient’s primary care physician prior to seeing an in-network specialist in one of the following specialty area:  Cardiology, Gastroenterology, Orthopedic Surgery, Dermatology and Rheumatology.

 

The attached flyer outlines the details of this program along with their referral process.  They will be offering training webinars in late March on the new requirements.  Please visit the following web site for dates, times and registration information.

Allwell Referral Requirements

https://www.homestatehealth.com/content/dam/centene/home-state-health/pdfs/AllwellReferralsProviderWebinarTrainings.pdf

Humana Claim Dispute Updates

February 06, 2018

Please review the attachment from Humana regarding changes to claim disputes effective 04/29/2018.

Humana Claim Dispute Updates

You can also view additional updates on their “What’s New”  web page at the link below.

Humana What’s New

 

Sunflower Provider Portal Enhancements – January 31

February 02, 2018

Portal Enhancements to Save You Time and Postage

We are happy to announce new document upload functionality is available on the Sunflower Secure Provider Portal.

You can now upload medical records securely, saving time and postage.

A login to the secure portal is required. Files may be up to 5 MB in size and can be in the following formats: .jpg, .pdf, .tif, and .tiff.

Secure Document Upload Instructions:

  • Login to the portal at https://provider.sunflowerhealthplan.com
  • Click “Eligibility”
  • Enter a Medicaid ID and DOB
  • Click “Check Eligibility”
  • Click on Member Name
  • Click on “Document Resource Center” on the left hand side (now on Document Upload tab)
  • Choose Document Category:
    • Medical Necessity (can be used for authorization related documents)
    • Quality Management
  • Choose Document Type:
    • Medical Necessity – Emergency Notes
    • Medical Necessity – Inpatient Notes
    • Medical Necessity – InterQual Smart Sheets
    • Medical Necessity – Other
    • Quality Management – Audit
    • Quality Management – EPSDT
    • Quality Management – HEDIS
    • Quality Management – Peer Review
    • Quality Management – Quality of Care
    • Quality Management – Risk Adjustment
    • Quality Management – Other
  • Attach file (5 MG size limit per file)
  • Click “Submit”

Please note that documents that are uploaded are available for viewing for three months after the upload date. Uploaded documents can be viewed under the Document Review tab.

PLEASE DO NOT PASSWORD PROTECT UPLOADED DOCUMENTS AS THE PORTAL IS SECURE.

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

Weekly KMAP Roundup Bulletin – January 25

January 30, 2018

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: EMERGENCY ROOM VISITS BILLED WITH NON-EMERGENT DIAGNOSIS
Effective January 19, 2018, and retroactive to dates of service on and after July 1, 2017, emergency room claims will no longer be reduced to procedure code 99281 based on a list of diagnosis codes. Emergency room claims must be billed appropriately, and medical records may be requested to be reviewed for coding accuracy. This applies to procedures 99282, 99283, 99284, 99285, 99291, and 99292. Read more …

KMAP BULLETIN: DEBRIDEMENT CODE COVERED
Effective with dates of service on and after March 1, 2018, code 11012 will be covered. Read more …

2018 Regional Provider Workshops
Our Provider Relations team focuses on face-to-face interactions, educational outreach and collaboration to solve provider concerns. Please join your Provider Relations partners at a venue near you for one of these training events!