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.

The attached has information regarding the extension of Humana’s prior authorization extension regarding Skilled Nursing Facilities through 01/31/2021.

Humana Prior Authorization Extension

Anthem Blue Cross Blue Shield has issued the attached communication temporarily revising the authorization requirements for patient transfers from acute inpatient hospital to skilled nursing facilities.  Authorizations will be suspended for these transfers from December 21, 2020, through January 15, 2021.  While prior authorization is not required, they continue to require notification of the admission via the usual channels and clinical records on day two of admission to aid in the members’ care coordination and management.

Anthem – COVID Authorization and Policy Updates 122220

Balance by Medica_2021_ID Card

Mercy will be contracted with Balance by Medica-a new narrow market exchange plan starting in January 2021 and if your group opted in you will also be participating.

Medica provides a variety of resources that can answer your questions about administrative requirements. Most of these resources and additional information are available online at www.medica.com in the Providers section, including:

• Medica credentialing policies and requirements
• Medica provider administrative manuals and guidelines
• Medical policies and guidelines
• Explanations of Medica products and membership, including government program member rights and responsibilities
• Grievance, appeal and State of Minnesota fair hearing rights
• Monthly online training for providers on various administrative topics
• Electronic transactions such as eligibility verification, claim status verification, and the ability to update practitioner and site-level demographics

This link directs you to the Balance by Medica page and contains information specific to this plan.

https://www.medica.com/shop-plans/individual-and-family/2021-health-plans/missouri/balance-by-medica

There will be a webinar on 12/17 from 1pm-2:30pm to review Self-Service resources for providers. Follow this link to register here on medica.com. 

This month’s featured articles…

Behavioral Health:

• Access requirements for behavioral health care services

Pharmacy:

• Prior authorization updates for specialty pharmacy are available – December 2020
• AIM IVR changes for non-oncology medical specialty drug reviews effective Jan. 1, 2021
• Pharmacy information available at anthem.com

Administrative:

• Provider education webinars!
• Reminder: Are you ready? Missouri legislation requires prior authorization requests be accepted electronically
• New Blue HPN® plans go live Jan. 1, 2021
• Pharmacy changes for Boeing members
• Updated Provider Manual posted to anthem.com
• Access to claim denial information is now self-service
• Updated BlueCard® Provider Manual available
• 2-minute videos to engage patients about preventive care
• Anthem makes going digital easy with the Provider Digital Engagement Supplement
• Anthem contracted air ambulance providers for Missouri
• PCP after-hours access requirements
• Coordination of care
• Members’ rights and responsibilities
• Important information about utilization management
• Case management program

Medical Policy & Clinical Guidelines:

• Medical policy and clinical guideline updates – December 2020
• Anthem expands hospice policy
• Updates to AIM Cardiology clinical appropriateness guidelines
• Updates to AIM Advanced Imaging clinical appropriateness guideline
• Updates to AIM Radiation Oncology clinical appropriateness guideline
• Transition to AIM Rehabilitative Services clinical appropriateness guidelines
• Clinical practice and preventive health guidelines available on anthem.com

Reimbursement Policies:

• Reimbursement policy update: Bundled services and supplies (Professional)

Medicare:

• 2021 Medicare Advantage individual benefits and formularies
• Medicare Advantage Group Retiree Member Eligibility, Alpha Prefix FAQ
• Medical policies and clinical utilization management guidelines update
• Policy Update: Emergency Department: Leveling of Evaluation and Management Services
• Digital transactions cut administrative tasks in half

Anthem Provider Newsletter – Missouri December 2020

Please review the attached update from Anthem regarding adjustments to prior authorization requirements and policies as a result of COVID-19.

Anthem COVID-19 Update – Prior Authorization and Other Policy Adjustments 112520

This month’s featured articles…

Pharmacy:

• IngenioRx Introduces new pharmacy network in 2021
• Prior authorization updates for specialty pharmacy are available – – November 2020

Administrative:

• Availity attachment tools for Anthem and affiliate payers – Live Webinars
• Clinical Laboratory Improvement Amendments (CLIA) Number – Additional Information
• Digital transactions cut administrative tasks in half 9
• Get the full picture of your patient’s health through their smartphone
• US Antibiotic Awareness Week

Medical Policy & Clinical Guidelines:

• Medical policy and clinical guideline updates – November 2020
• Correction to Prior Authorization Update for Commercial business
• Reminder: Post-service reviews using AIM

Reimbursement Policies:

• New reimbursement policy: Documentation standards for episodes of care (Professional)
• Reimbursement policy update: Bundled services and supplies (Professional)
• Reimbursement policy update: Modifier rules (Professional)

Medicare:

• Medicare News – November 2020
• Provider Chat: A fast, easy way to get your questions answered
• Digital transactions cut administrative tasks in half
• FDA approvals and expedited pathways used – new molecular entities

Anthem Provider Newsletter – Missouri November 2020

This quarter’s featured articles…

FEATURE ARTICLE

• Cigna launches five-year initiative to combat systemic racism

POLICY UPDATES

• Preventive care services policy updates
• Clinical, reimbursement, and administrative policy updates
• Precertification updates

ELECTRONIC TOOLS

• Register to receive InstaMed patient payments
• How to request fee schedules online
• View your patients’ benefits by procedure code
• Online claim reconsideration requests
• Online claim appeals coming soon
• Webinar schedule for digital solutions

CONNECTED CARE

• Staying connected with your patients through virtual care
• Empathizing may be key to improving your patients’ health
• Cigna Resilience Index: 2020 U.S. Report
• Educating your patients about gun safety

NETWORK UPDATES

• Cigna Gene Therapy Program

CLINICAL NEWS

• Cigna’s flu shot campaign

QUALCARE NEWS

• COVID-19 resources
• Workers’ compensation, HMO, and PPO plans in focus
• Change Healthcare billing and claims processing requirement

PHARMACY NEWS

• Changes in drug formulary effective January 1, 2021
• Medical oncology clinical decision support enhancement
• Oncology clinical pathway program
• Accredo’s digital tools help your patients manage medications
• Transition to Express Scripts Pharmacy: Reminder

MEDICARE NEWS

• 2021 Cigna Medicare plan highlights

GENERAL NEWS

• Cigna launches Evernorth, a new brand
• eviCore to expand its management of certain Cigna services
• Home infusion therapy transition
• Cigna Centers of Excellence for hospitals
• High-tech radiology site of care medical necessity review program expansion
• Accountable Care program roster enhancement:
• Add providers monthly
• Patient concerns or complaints
• Cigna Shared Administration Repricing

REGIONAL NEWS

• Cigna + Oscar plans launched in Georgia and Tennessee
• Cigna and Priority Health announce new Strategic Alliance
• California provider access and availability

• MA law: Pain management alternative services and medications

COMMUNITY GIVING

• Cigna supports pipeline of superintendents of color

HELPFUL REMINDERS

• Market Medical Executives contact information
• Updated Cigna reference guides now available
• Use the Network
• Patient reviews reminders
• Quick Guide to Cigna ID Cards
• Urgent care for nonemergencies
• View drug benefit details using real-time benefit check
• Knowledge with CareAllies education series
• Resources to enhance interactions with culturally diverse patients
• Have you moved recently? Did your phone number change?
• Get digital access to important information
• Access the archives
• Letters to the editor

Cigna Network News 4th Quarter 2020

Please review the attached notice from Cigna regarding to changes to their drug formulary effective January 1, 2021.

Cigna – Drug Formulary Changes 010121

Please review the attached announcement from Cigna regarding a revision to their Biosimilar coverage policy adding KANJINTI to the preferred list of trastuzumab biosimilars.

Cigna – Coverage Policy Updates – Biosimilar Coverage 100120

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

allwell from home state authorization list 2021