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 January , 2021

January 05, 2021

This month’s featured articles…

 

Pharmacy:

  • IngenioRx introduces new pharmacy network in 2021
  • Prior authorization updates for specialty pharmacy are available – January 2021

Administrative:

  • It is almost CAHPS survey time!
  • Evaluation and management changes 2021
  • Outpatient system updates for 2021 – Facility
  • Professional system updates for 2021
  • New features added to Interactive Care Reviewer
  • Availity attachment tools for Anthem and affiliate payers – Live webinars
  • Self-service, digital transactions are fast and easy

Medical Policy & Clinical Guidelines:

  • Medical Policy and Clinical Guideline Updates – January 2021
  • MCG Care Guidelines 24th Edition Customization

Reimbursement Policies:

  • Reimbursement policy update: Multiple diagnostic imaging procedures – Professional
  • Reimbursement policy update: Frequency editing – Professional
  • Reimbursement policy update: Guidelines for reporting timed units for physical medicine and rehabilitation – Professional
  • Reimbursement policy update: Modifier Rules – Professional
  • Reimbursement policy update: Unit frequency maximum for drugs and biologicals – Professional

Federal Employee Plan (FEP):

  • 2021 FEP® benefit information available online

Medicare:

  • Keep up with Medicare news – January 2021
  • 2020 Medicare risk adjustment provider trainings
  • Updates to AIM clinical appropriateness guidelines for Advanced Imaging
  • Updates to AIM Specialty Health Cardiac clinical appropriateness guidelines
  • Medical drug benefit clinical criteria updates

Anthem Provider Newsletter – Missouri January 2021