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.

Cigna – Inflammatory Drug Class Changes Effective 1/1/2020

December 16, 2019

Please review the attached reminder from Cigna regarding changes to quantity limits on certain drugs within the inflammatory drug class.  These changes go into effect on January 1, 2020.

Cigna – Imflammatory Drug Class Changes Effective 01012020

Cigna – Policy Updates First Quarter, 2020

November 25, 2019

Please review the following policy updates and changes that Cigna will implement during the first quarter of 2020.

  • Allergy Testing and Non-Pharmacologic Treatment
  • Anesthesia Services for Interventional Pain Management Procedures (Adults)
  • Care Integration Services
  • Evaluation and Management and Joint Injection Codes
  • Incontinence Supplies

Cigna – Policy Updates First Quarter 2020

Ambetter Payment and Clinical Policies Update

November 19, 2019

Please see the attached provider notice regarding payment and clinical policy updates for the Ambetter program that will be effective on January 15 2020.

Please keep in mind that this only applies to the Ambetter program.

Ambetter Payment and Clinical Policies Effective 011520

Home State Health Synagis Injections

November 13, 2019

Please view the attached reminder from Home State Health-Medicaid regarding Synagis injections.


Ambetter from Home State Health Provider Notice for 2020

November 05, 2019

Product:  Ambetter from Home State Health (Marketplace)

Good morning,

Attached, please find our Ambetter from Home State Health Provider Notice regarding 2020, which includes a thank you for being partners in care!  We reference resources on our website www.Ambetter.HomeStateHealth.com, along with key benefit information and our 2020 geographic map, noting where our Ambetter members in 2020 reside.   Marketplace Open Enrollment began on November 1st and continues until December 15h.

Please review this information within your group/practice as necessary.

Ambetter 2020 Provider Notice