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.

UPDATE – 10/27/2021

Cigna recently notified us that eviCore healthcare (eviCore) would begin providing utilization management and case management services for sleep studies for customers with Tufts-administered Carelink® plans on November 1, 2021.  However, they want to make you aware that they have changed the effective date to January 1, 2022.

Cigna has issued the attached announcement regarding precertification for sleep studies.  eviCore healthcare ( eviCore) provides utilization management and case management services for sleep studies for Cigna customers nationwide.  Effective November 1, 2021, they will expand this program to include customers with Tufts-administered CareLink® plans.

Cigna – Sleep Study Precertification 110121

Cigna – UPDATE Sleep Study Precertification 010122

This morning, our office received the following message from Aetna Better Health, along with the attached notice, regarding a number of letters that were sent to their members in error.

During the course of a data cleanup project to end-date practitioner affiliations which were no longer active, there were a number of letters generated to members in error advising that their PCP had terminated and that they would need to choose a new provider.  We have sent out corrected letters to those members impacted, however also have posted the attached bulletin on our website as a provider notice as well in case you might receive calls from the member.   We apologize for any confusion, however in addition to the updated letter sent to the member and the attached bulletin, if you do happen to get any calls from members with a continued concern please direct them to customer service for more assistance.

 We apologize for any confusion this might have cause the member and the clinic.

aetna better health incorrect letter notice 090121

This month’s featured articles…

Administrative:

• National Accounts 2022 Pre-certification list
• Register now for our September CME webinars
• Statin therapy for patients with diabetes
• Six SIMPLE strategies to help increase medication adherence
• Cure for the common cold: Rest, fluids and this free prescription pad
• HEDIS® medical record submission made easier with our Remote EMR Access Service

Digital Tools:

• Get your payments faster when you sign up for electronic funds transfer

Pharmacy:

• Updates for specialty pharmacy are available – September 2021

Reimbursement Policies:

• Reimbursement policy update: Sexually transmitted infections testing – Professional
• New reimbursement policy update: Inpatient Facility Transfers – Facility
• Reimbursement policy update: Drug Screen Testing – Professional

Medicare:

• Keep up with Medicare news – September 2021
• Reimbursement Policy Update: DRG Inpatient Facility Transfers
• Utilization management authorization rule operations
• Prior authorization form notification

Anthem Provider Newsletter – Missouri September 2021

Effective September 1, 2021, the employer group Liberty Utilities (formerly Empire District Electric) will change their claims administrator from HealthScope Benefits to UMR.  They will continue to access the Mercy network through their direct agreement.

Please review the attached memo for additional information along with sample identification cards.

liberty utilities claims admin change 082621 2

Effective August 15, 2021, the insurance plan doing business under the name USAble Corporation will cease operation. This plan was offered by Arkansas Blue Cross Blue Shield and primarily marketed in areas outside the State of Arkansas. Mercy held contracts with this insurance in the Springfield, Fort Smith and NW Arkansas Communities.

They have advised that any remaining business has been transferred to TrueBlue PPO, a PPO plan through Arkansas Blue Cross Blue Shield. This should have little, if any, effect on patients receiving care at Mercy hospitals or clinics.

Aetna has released the attached communication update regarding temporary changes to their prior authorization/precertification process for skilled nursing facility admissions.

Prior Authorization Notification 8.11.2021

This month’s featured articles…

Administrative:

• Register now for our August CME webinar
• Telehealth visits can impact after hospitalization follow-up care for mental illness
• Clearing up coding confusion for retinal eye exams (DRE)

Digital Tools:

• New! Schedule appointments online through Availity

Pharmacy:

• Anthem to update formulary lists for commercial health plan pharmacy benefit effective October 1, 2021
• Updates for specialty pharmacy are available – August 2021
• Specialty dose rounding program for certain oncology medications
• Specialty dose rounding program for certain non-oncology medications beginning August 1, 2021
• Immune globulin adjusted body weight dosing program beginning August 1, 2021
• Pharmacy information available at anthem.com

Medical Policy & Clinical Guidelines:

• Transition to AIM Specialty Health imaging of the heart clinical appropriateness guideline for computed tomography to detect coronary artery calcification

Reimbursement Policies:

• Reimbursement policy update: Virtual Visits (Professional and Facility)
• Reimbursement policy update: Claims requiring additional documentation (Facility)
• Reimbursement policy update: Distinct Procedural Service, Modifiers 59 and XE, XP, XS, & XU

Federal Employee Plan (FEP):

• Change in email submission of service requests for Federal Employee Program® members

Medicare:

• Medicare News – August 2021
• Preventing claims denials: Shingles vaccine

Anthem Provider Newsletter – Missouri August 2021

Due to the rise in Covid 19 cases Humana has decided to suspend authorization requirements for skilled nursing facilities for Medicare Advantage member for the entire state of Missouri through 08/27/2021.

• You will still need to provider notification of admission within 24 hours
• This applies only to participating/in-network providers
• No other services that require prior authorization is included in this suspension

You can view the memo below.

Humana Skilled Nursing Covid 19 Waiver

Attached you will find the 3^rd Quarter Network News along with the updated precert list for August 2021.

Communication for the following:

• Enhanced Online Reconsideration Feature as well as Digital Solutions Webinar dates.
• Cigna Virtual Care Reimbursement Policy
• Preventive Care Updates
• Venipuncture Update effective 10.16.2021
• Coverage of Reimcade effective 7.1.2021
• Musculoskeletal Precertification – eviCore
• Expedited Appeal Submission Tips

Cigna Network News 3rd Quarter 2021

Cigna Master Precertification List August 2021

This month’s featured articles…

Administrative:

• Register now to learn strategies to help you and your practice improve clinical quality
• Timely receipt of primary payer’s EOB can help reduce timely filing denials for secondary claims
• Proper coding for in-home monitoring can make a measurable difference for INR
• Another mark of the pandemic: An increase in childhood obesity

Digital Tools:

• How to enroll in electronic fund transfer (EFT) for faster remittance
• Electronic claim response files
• Interactive Care Reviewer (ICR): New search option for cases submitted through ICR

Products & Programs:

• Company to retire Blue Precision program at the end of the year

Pharmacy:

• Update: Site of care medical necessity reviews for long-acting colony-stimulating factors not implemented on June 1, 2021
• Update on requirement to obtain certain specialty drugs from CVS Specialty Pharmacy effective October 1, 2021
• Updates for specialty pharmacy are available – July 2021
• Certain specialty medication prior authorization requests may require additional documentation

Medical Policy & Clinical Guidelines:

• Medical Policy and Clinical Guideline Updates – July 2021
• Reminder: Updated AIM rehabilitative program effective August 1, 2021 – Site of service reviews

Reimbursement Policies:

• New reimbursement policy: Non-patient laboratory services – Facility
• Reimbursement policy update: Consultations – Professional

Medicare:

• Medicare News – July 2021
• Let’s Vaccinate
• Attention facilities: Sending admission, discharge and transfer data to Anthem results in improved care management for patients
• Medical drug benefit clinical criteria updates
• Prior authorization requirement changes for codes A0426 and A0428 effective October 1, 2021
• New reimbursement policy: Modifier 90: Reference (outside) laboratory and pass-through billing

Anthem Provider Newsletter – Missouri July 2021