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 from Home State Health- My Health Pays

May 21, 2019

Please review the attached flyer from Allwell from Home State Health.  They have rolled out an incentive program for their members where they receive rewards for certain healthcare services such as routine checkups and screenings.

Allwell_Medicare-MyHealthPays-MO_V2 051519

Cigna – Facility Reimbursement Policy Update

April 22, 2019

Please review the attached correspondence from Cigna regarding updates to their policy for facility reimbursement and outpatient code editing.

Cigna – Facility Reimbursement Update 071519

Cigna – Continuous Glucose Monitors – Expanded Pharmacy Benefits Coverage

April 10, 2019

Please review the attached correspondence from Cigna regarding coverage of continuous glucose monitors.  Cigna is expanding coverage of two therapeutic CGM systems under the pharmacy benefits of eligible patients with Cigna pharmacy benefits.

Cigna – Continuous Glucose Monitors 040119

Allwell from Home State Health – Provider Notice: Balance Billing

April 02, 2019

Product:  Allwell from Home State Health

Good afternoon,

Please review the attached provider notice, serving as a reminder that balance billing is strictly prohibited.

This publication, along with past Allwell provider notices are housed on our website here:

https://www.homestatehealth.com/providers/allwell-provider-materials.html

–          News and Announcements

Allwell QMB Provider Notification_HSH 3.20.19_032919

Ambetter Behavioral Health Prior Authorization Change

April 02, 2019

Product– Ambetter Behavioral Health

Summary of Change- Effective May 6, 2019 we will be converting to a new prior authorization form for behavioral health services.

NOTE The fax number to submit a behavioral health request has changed 855-690-5433

Why are these changes necessary? Our current “Outpatient Treatment Request” form is several pages long and confines you to our form’s format for supporting clinical documentation. Our new “Prior Authorization Form” is a single page and will allow you to submit clinical data in any form.

Ambetter BH Prior Auth Provider Communication 040119

Home State Health Provider Notice: Opioid Crisis – Message from Chief Medical Officer

March 15, 2019

Please review and she this important notice from Home State Health’s Chief Medical Office, Dr. Sharon Deans.

 

Products:

Home State Health (Medicaid)

Ambetter from Home State Health (Marketplace)

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

HSH MO ASAM-Provider-Training_Email-1(WebLinks)