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.

Anthem Missouri Updates – Rehabilitative Program Update

July 03, 2019

Anthem Blue Cross and Blue Shield (Anthem) previously communicated in the April 2019 edition of Anthem Provider News that AIM Specialty Health® (AIM), a separate company, would begin to perform prior authorization review of rehabilitative (restoring function) and habilitative (enhancing function) services for Anthem fully insured members beginning July 1, 2019. Due to recent group membership, provider status, and system issues experienced by Anthem and AIM, the program will now be implemented on August 1, 2019.

Please review attached update.

Anthem Missouri Update – Rehabilitative Program Update

Meeks Building Centers Contract Update

June 20, 2019

We’ve been made aware that as of 01/01/2019 Meeks Building Centers will not be accessing Mercy and their affiliates via a direct contract.  Meeks is now obtaining care through Cigna and your participation will be based on your contract status with Cigna.

Claims run-out was handled by Med-Pay through 03/31/2019.

 

 

Home State Medicaid Faxblast

June 20, 2019

Please review the attached for billing guidelines when behavioral health services are billed by non-behavioral health providers.

Depression_BipolarAwareness Faxblast

Home State Health- Web Portal Authorization Redesign

June 11, 2019

Products:

Home State Health (Medicaid)

Ambetter from Home State Health (Marketplace)

Allwell from Home State Health (Medicare HMO, D-SNP)

Home State Health is pleased to announce, effective of 07/01/19, the redesign of our medical and behavioral health web authorization requests in our Secure Provider Portal, adding features that will simplify the provider experience and enhance your ease of doing business with our Health Plan.

Provider Notice Web Portal Auth Redesign_Final

Web Portal Auth Redesign 062019

Cigna Specialty Pharmacy transition to Accredo – July 13, 2019

June 03, 2019

Please review the attached information regarding the transition of Cigna Specialty Pharmacy to Accredo beginning July 13, 2019.

Cigna Specialty Pharmacy Transition 071319

Cigna – Medical Coverage Policy Updates – August, 2019

May 28, 2019

Please review the following medical policy updates from Cigna.

  • Drug-eluting stents following endoscopic sinus surgery
  • Orthotic prescriptions with no evaluation
  • Vitamin D testing
  • Spinal fusion-related services
  • Venous angioplasty with or without stent placement

Cigna – Medical Coverage Policy Updates effective August 2019