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 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 via I Need To… ǀ Providers ǀ Mercy Provider and Payor Networks | Mercy Provider Network. Please include a W-9 Form if the change involves a new billing address or tax identification number.

Payor Resource Links

The below grid contains resource links to payers Mercy is contracted with.  It contains quick access to the payor websites and provider manuals for each our payors. *** Please login to your provider Contract Matrix here: Health Plans | Mercy Provider Network to see a current health plan list for a breakdown of all contracted payors, products, and network names that your practice opted into for participation.***

Payor Resource Links 2026

Please review the attached medical policy from Cigna to review the medical necessity of Flow Cytometry.  This policy goes into effect on May 20, 2019.

Cigna – Flow Cytometry 052019

Please review and share the attached announcement from Home State Medicaid regarding a change to their authorization requirements for outpatient physical, occupational and speech therapy.

Medicaid- Therapy Prov Notice 03.01.19

Please review the attached announcement from Allwell regarding a change to their authorization requirements for outpatient physical, occupational and speech therapy.

Allwell – Therapy Prov Notice 03.01.19

Please view the provider notice received from Home State Medicaid regarding the billing of T1015 by Independent RHC clinics. 

T1015 IRHC Provider Communication Feb 2019_021819

Copy and Paste the following link:

http://view.messageinsite.com/?qs=ee41cb31c4b727d6491599dd0d578085c032d19a80f1ea8a04f7722ad681cd90f40f6da9a1af821f527660c8928a451ef4aa28a5f1290152d8f5724bce578d2eaa9dbb3e0f26500c

Copy and paste the following link:

http://links.mkt2161.com/servlet/MailView?ms=MTUxOTE5NTMS1&r=MzQzODYxNjU0MDAzS0&j=MTU4MjAyMjM5MQS2&mt=1&rt=0

Cigna – Reimbursement Policy for Infusion and Injection Services 050119

Please see the attached fax blast regarding Part B Drugs.

Home State Health requires prior authorization as a condition of payment for many services. This Notice contains information regarding such prior authorization requirements and is applicable to all Medicare products offered by Home State Health.

It is the ordering provider’s responsibility to determine which specific codes require prior authorization. Effective May 1, 2019, prior authorization requirements will be added to the Part B Drugs. A listing of the Part B drugs that will require prior authorization can be found on our website www.homestatehealth.com, For Providers, Allwell Provider Materials, News and Announcements.

Refer to the Pre-Auth Needed tool for services that require an authorization. There is also a list of Frequently Asked Questions on the attached fax blast for your review.

Allwell – Prior Authorization Update Eff_050119_012919

Cigna is implementing a new medical coverage policy to review peripheral angioplasty procedures for medical necessity.  This policy will be effective for dates of service beginning April 1, 2019.

Cigna Policy Update – Peripheral Angioplasty Procedures 04.01.2019

Allwell Part B Step Therapy 121318