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 Provider Newsletter – Missouri December, 2021

December 01, 2021

This month’s featured articles…



  • Prepare for the Consolidated Appropriations Act: Keep your provider directory information up to date
  • Professional system updates for 2022
  • Outpatient system updates for 2022
  • Chlamydia is asymptomatic. Only through screening will we know for sure
  • Behavioral healthcare appointment access requirements
  • Importance of PCP after-hours messaging
  • Important information about utilization management
  • Case management program
  • Member rights and responsibilities
  • Coordination of care
  • Clinical practice and preventive health guidelines available on anthem.com

Digital Tools:

  • Reminder: EnrollSafe is available – electronic funds transfer enrollment portal for Anthem providers

Products & Programs:

  • Company to retire Blue Precision program on December 31, 2021


  • Specialty pharmacy updates – December 2021
  • Pharmacy information available at anthem.com

Medical Policy & Clinical Guidelines:

  • Medical policy and clinical guideline updates – December 2021
  • Updates to AIM Specialty Health Musculoskeletal Interventional Pain Management Clinical Appropriateness Guideline
  • Updates to AIM Specialty Health Cardiology Clinical Appropriateness Guidelines
  • Updates to AIM Advanced Imaging Clinical Appropriateness Guideline
  • Updates to AIM Specialty Health Radiation Oncology Clinical Appropriateness Guideline

Reimbursement Policies:

  • RETRACTION: Inpatient Facility Transfers – facility reimbursement policy
  • Reimbursement policy update: Assistant at Surgery (Modifiers 80, 81, 82, AS) – Professional
  • New reimbursement policy update: Modifier 62: Co-Surgeon Services and Modifier 66: Surgical Teams – Professional
  • Reimbursement policy update: Virtual Visits – Professional and Facility


  • Keep up with Medicare News – December 2021
  • 2022 Medicare Advantage service area and benefit updates
  • Adjudicating claims for COVID-19 vaccines, their administration and COVID-19 monoclonal antibodies
  • Reimbursement policy update: Drug screen testing
  • Updates to AIM Specialty Health Advanced Imaging Clinical Appropriateness Guidelines
  • Good news: Non-payment remittance advice enhancements are here
  • Somatus is your resource for kidney care management

Anthem Provider Newsletter – Missouri December 2021

Cigna: New Reimbursement Policy: Unacceptable Principal Diagnosis Codes

November 29, 2021

On February 12, 2022, Cigna will implement a new reimbursement policy, Unacceptable Principal Diagnosis Codes (R38), for claims billed with an unacceptable principal diagnosis code.  Unacceptable principal diagnosis is a coding convention in ICD-1O.  Those identified codes do not describe a current illness or injury, but a circumstance which influences a patient’s health status. These codes are considered to be unacceptable principal diagnosis codes.

Cigna – New Reimbursement Policy – Unacceptable Principal Diagnosis Codes

Cigna Policy Updates – February, 2022

November 10, 2021

Pulse oximetry claims billed with Current Procedural Terminology codes 94760, 94761, and 94762

Effective Date:  February 22, 2022

873827_ExternalHCP_Template2014_V2 (graphnet.com)

Outpatient facility blood draw and venipuncture claims

Effective Date:  February 12, 2022

873827_ExternalHCP_Template2014_V2 (graphnet.com)

Physical therapy services billed with Current Procedural Terminology codes 97016 and 97026

Effective Date:  February 12, 2022

873827_ExternalHCP_Template2014_V2 (graphnet.com)

Allwell from Home State Health – 2022 Provider Notification for Non-Formulary Drugs

November 09, 2021

Allwell from Home State Health has announced changes to their formulary effective January 1, 2022.

Please review the attached flyer.

allwell formulary changes 010122

Anthem Provider Newsletter – Missouri November, 2021

November 01, 2021

This month’s featured articles…


  • CME credits available in 2021 for a variety of clinical quality webinars – register now!
  • Join Anthem in talking about racism and its impact on health, and earn continuing education credits!
  • Anthem Alliance EPO 2022 prior authorization list for Commercial accounts
  • Blue High Performance Network name changing for 2022
  • Include referring provider name and NPI on home infusion therapy and ambulatory infusion suite professional claims
  • Change in coverage for continuous glucose monitors for some fully insured groups
  • Time to prepare for HEDIS medical record review
  • Reducing the burden of medical record review and improving health outcomes with ECDS reporting
  • Be Antibiotics Aware: Protect your patient
  • Surprisingly easy ways to help patients quit smoking cigarettes

Digital Tools:

  • Against medical advice (AMA) discharge physician tracking Tool
  • EnrollSafe is available: Our new electronic funds transfer enrollment portal for Anthem providers

Products & Programs:

  • Update regarding annual wellness visits for ACA-compliant health plans


  • Specialty pharmacy updates are available – November 2021
  • Important update on Botox for Anthem members

Reimbursement Policies:

  • Clarification to reimbursement policy updates: Modifier Rules and Guidelines for Reporting Timed Units for Physical Medicine and Rehabilitation – professional


  • Keep up with Medicare News – November 2021
  • Anthem offering Advance Medical Directives program for 2022
  • Updates to AIM Specialty Health Cardiology Clinical Appropriateness Guidelines
  • New York City Medicare Advantage announcement
  • Clinical criteria updates
  • Electronic data interchange process

Anthem Provider Newsletter – Missouri November 2021

Cigna Network News – 4th Quarter 2021

October 26, 2021

This quarter’s featured articles…



  • Help your patients understand their after-hours care options


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


  • Procedure code benefit lookup
  • Webinar schedule for digital solutions


  • Referral essentials: The important role of PCPs
  • Tips for rescheduling patient appointments


  • Cigna and Oscar Health plans expand
  • LocalPlus plans expand to Maryland
  • Cigna Gene Therapy Program


  • Guide patients to tobacco dependence treatment


  • Cigna completes deal for Mitchell | Genex | Coventry to acquire QANI
  • Reminder: Workers’ compensation, HMO, and PPO plans in focus


  • Changes in drug formulary effective January 1, 2022
  • Therapeutic continuous glucose monitors coverage change
  • Digital health trackers for Accredo patients
  • Specialty Medical Injectables with Reimbursement Restriction


  • 2022 Cigna Medicare Advantage plan highlights
  • Cigna Medicare Advantage COVID-19 updates
  • 360 Comprehensive Assessment
  • Claim editing enhancement
  • Behavioral health resources
  • Prevent payment delays: Update your address


  • Surgeon becomes Cigna’s first academic fellow
  • Social determinants of health digital guide for providers
  • COVID-19 vaccine updates
  • COVID-19 monoclonal antibody treatment
  • LGBTQ+ directory enhancement
  • Musculoskeletal site-of-care review
  • Reminder: High-tech radiology program
  • Oncology clinical consult service
  • eviCore’s new peer-to-peer clinical consultation scheduler
  • Precertification of certain gastroenterology procedures
  • Tips to prevent balance billing
  • Patient concerns or complaints
  • Medical record requests: Thank you for responding


  • California provider directory update requirement
  • Quarterly notification of Maryland nonparticipating specialists


  • Market Medical Executives contact information
  • How to contact us
  • Cigna Reference Guides
  • 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
  • Transformations behavioral health digital newsletter
  • CareAllies education series
  • Cultural resources you can use
  • 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 2021

Cigna – NCCI Edit Expansion Effective 11/14/2021

October 13, 2021

As a result of a recent review·, Cigna will expand their current National Correct Coding Initiatives (NCCI) edits to apply for participating facilities with mixed percent of charges (POC) contracts for outpatient (UB-04) claims.  This update is effective for claims processed on or after November.14, 2021. Administrative appeal rights are available.

Cigna – NCCI Expansion 111421

Cigna – Precertification Update for Gastroenterology Procedures

October 11, 2021

Effective January 1, 2022, precertification for the gastroenterology procedures listed below will be included in the list of outpatient services requiring precertification for most Cigna commercial (non-Medicare) customers whose plan requires outpatient precertification.

  • Esophagoscopy/Esophagogastroduodenoscopy (EGO)
  • Most capsule endoscopies

Cigna’s goal is to help ensure that these tests and procedures are medically necessary according to evidence-based guidelines.  They have delegated precertification of these procedures to eviCore healthcare.

Cigna – Precertification Update for Gastroenterology Procedures 010122

Medica October 2021 Connections

October 11, 2021

Please review the Medica 2021 Connections to review for applicable updates.  Keep in mind, if you’re included under this contract through Mercy, you’re only participating  in the Balance by Medica plan.

Oct2021Conn – Final

Anthem Provider Newsletter – Missouri October, 2021

October 01, 2021

This month’s featured articles…



  • Looking to earn CME credits? Register for these on-demand webinars!
  • Federal Price Transparency and Consolidated Appropriations Act phase in new mandates beginning January 1, 2022
  • Your recommendation is key to encouraging cancer screenings for your female patients
  • Are you talking to ALL of your patients about breast cancer screenings?
  • Clarification: Anthem’s enhanced claim edits for outpatient facility claims
  • Good news! Non-payment remittance advice enhancements coming soon
  • Clinical appeals

Digital Tools:

  • Reminder: EnrollSafe, the new EFT enrollment portal for Anthem providers replacing CAQH Enrollhub effective November 1, 2021
  • Procedure searches in Find Care


  • Specialty pharmacy updates are available – October 2021
  • Update on requirement to obtain certain specialty drugs from CVS Specialty Pharmacy effective January 1, 2022
  • Pharmacy information available at anthem.com

Medical Policy & Clinical Guidelines:

  • Medical policy and clinical guideline updates – October 2021
  • Continuation of skilled nursing facility (SNF) program in Missouri

Reimbursement Policies:

  • New reimbursement policy: Multiple and Bilateral Surgery Processing – Facility
  • Reimbursement policy clarification: Claims requiring additional documentation – Facility


  • Keep up with Medicare news – October 2021
  • New reimbursement policy: Sexually transmitted infections testing (Professional)
  • Information about 2021 Special Needs Plans
  • HEDIS medical record submission made easier with our Remote EMR Access Service
  • New medical step therapy requirements.

Anthem Provider Newsletter – Missouri October 2021