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.

Home State Health Ear, Nose & Throat Surgeries and Sleep Study Program

October 12, 2020

Home State Health is pleased to announce the launch of a new and innovative Ears, Nose, & Throat (ENT) Surgeries & Sleep Study Management Program. The program is designed to work collaboratively with physicians to promote patient safety through the practice of high quality and cost-effective care for Home State Health members undergoing ENT Surgeries and/or Sleep Study Management Procedures.
For program highlights and frequently asked questions please visit our provider resources News and Announcements as well as Reference Materials at www.HomeStateHealth.com

Ears, Nose & Throat PDF





Home State Health Clinical and Payment Policy Updates for January 01/20201

October 12, 2020

The updates apply to these policies:

  • Non-Obstetrical and Obstetrical Transabdominal and Transvaginal Ultrasounds
  • Renal Hemodialysis
  • Multiple Procedure Payment Reduction for Therapeutic Services
  • Multiple Procedure Payment Reduction for Ophthalmology
  • Homocysteine Testing
  • Attention Deficit Hyperactivity Disorder Assessment and Treatment

Home State Health Policy Updates

Anthem Provider Newsletter – Missouri September 2020

September 01, 2020

This month’s featured articles…


Products & Programs:

  • Site of care medical necessity reviews expands to numerous surgical procedures beginning December 1, 2020
  • Meet your Cancer Care Navigator
  • Predictive analytics guide proactive support to patients undergoing chemotherapy resulting in lowered admissions


  • Anthem to update formulary lists for commercial health plan pharmacy benefit
  • Specialty pharmacy updates are available – September 2020


  • New provider directory indicators for medication assisted treatment (MAT) providers
  • The 2020 Provider Manual is now available
  • Eye exam benefit for St. Louis police
  • EDI Gateway migration deadline is September 15, 2020
  • Providers can now receive and respond to medical record requests for post-pay audit via Change Healthcare’s Assurance Attach Assist Module
  • Enhanced medical records submission process to support claims processing
  • Patient360 adds care gap alert feedback for medical providers
  • Anthem Commercial Risk Adjustment (CRA) Reporting Update:  2020 Prospective Program continues

Reimbursement Policies:

  • Reimbursement policy update: Distinct Procedural Services-Modifiers 59, XE, XP, XS, XU (Professional)
  • Reimbursement policy update: Frequency Editing (Professional)


  • Update: Notice of changes to the AIM musculoskeletal program
  • Medical drug benefit clinical criteria updates
  • IUOE 513 Welfare Fund moves to Anthem Medicare Preferred (PPO) medical plan

Anthem Provider Newsletter – Missouri September 2020

Aetna Monthly Updates – News You Need to Know August, 2020

August 03, 2020

This month’s update from Aetna…

·         Important changes to advanced reproductive technologies (ART) benefits

Aetna Monthly Update August 2020

Cigna Network News – 3rd Quarter 2020

August 03, 2020

This month’s featured articles…


  • Health disparities worsened by COVID-19: Provider resources


  • Preventive care services policy updates
  • Precertification of certain gastroenterology procedures for Individual & Family Plans
  • High-tech radiology site of care medical necessity review


  • Quicker option to submit pended claim documentation
  • Coming soon: Online claims reconsideration requests
  • Coming soon: Online benefit viewing through procedure code lookup
  • Webinar schedule for digital solutions


  • Pap smears and bimanual pelvic exams under age 21 usually unnecessary


  • New QualCare section of Network News
  • QualCare and Qual-Lynx workers’ compensation COVID-19 updates A NETWORK NEWS • THIRD QUARTER 2020


  • Lowering medication costs for those without coverage
  • Site of care review for pegfilgrastim products effective September 1
  • Expansion of Specialty Medical Injectables with Reimbursement Restriction list
  • Accredo to provide specialty home infusion services
  • Specialty medication prior authorization outreach program
  • Digital connectivity capabilities through Accredo
  • Oncology clinical consult service
  • Transition to Express Scripts Pharmacy: Reminder


  • Important annual screenings
  • Cigna Gene Therapy Program
  • Final CMS regulations give patients greater control of health care information
  • PPACA risk adjustment: Accurate claim coding may benefit your patients
  • Providers must meet language assistance compliance requirements


  • Market Medical Executives contact information
  • Updated Cigna Reference Guides Available Fall 2020
  • Quick Guide to Cigna ID Cards:  Interactive digital tool
  • Urgent care for non-emergencies
  • View drug benefit details using real-time benefit check
  • Increase your 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

Cigna Network News 3rd Quarter 2020 (002)

Anthem Provider Newsletter – Missouri August, 2020

August 03, 2020

This month’s featured articles…



  • Anthem to update formulary lists for commercial health plan pharmacy benefit
  • Voluntary site of care outreach for oncology checkpoint inhibitors beginning August 1, 2020
  • Anthem prior authorization updates for specialty pharmacy are available – August 2020
  • Pharmacy information available on anthem.com


  • Provider contract and fee schedule notifications coming soon Resources to support diverse patients and communities
  • Evaluation and management services correct coding (Professional)
  • Migrate your EDI transactions to Availity today
  • Electronic claims submission – Clinical Laboratory Improvement Amendments (CLIA)
  • Anthem electronic attachments – X12 275 5010
  • Coming soon: Enhance your prior authorization and inpatient admission and discharge notification via electronic and digital self-service for 2020
  • Medical record standards
  • Appropriate coding helps provide a comprehensive picture of patients’ health

Medical Policy & Clinical Guidelines:

  • Medical policy and clinical guideline updates – August 2020
  • Expansion of AIM Musculoskeletal Program effective November 1, 2020

Reimbursement Policies:

  • Reimbursement Policy Update: Claims requiring additional documentation (Facility)


  • Medicare News – August 2020
  • Medical drug benefit clinical criteria updates
  • 2020 Medicare risk adjustment provider trainings

Anthem Provider Newsletter – Missouri August 2020