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.

Please find attached the revised provider commination surrounding the Dispute and Appeal Process.  It has been updated to show Peer to Peer process and when it should be used.

Healthy Blue- Claims Dispute and Appeals process_FINAL July 2022

Please let you staff know of these changes and share the document or it may also be found at the following link:

https://provider.healthybluemo.com/missouri-provider/resources/forms

There has been an update to the BJC Employee Plan, Account # 3335018.  The plan has decided to allow Mercy hospital services at the in-network benefit level dating back to 1/1/2021.

What this means to you –

• All prior claims that processed Out of Network, will be reprocessed as In Network according to the OAP contract rate with a retro effective date of 1/1/2021.

• Cigna has started reprocessing claims for the BJC employee account.  Beginning December 20th, you will start to see corrected and adjusted EOBs.

• Mercy will now see the BJC Employee Plans appearing as In-Network on Cignaforhcp.com and this information will be shared when calling into Cigna to verify eligibility and benefits.

• Please allow up to 60 days for the full reprocessing of the BJC Employee claims.

• Claim inquiries and appeals should be directed to Cigna Customers Service.

• As of 1/1/2022, Mercy will be in-network for BJC’s benefit plan, unless a BJC employee has elected the LocalPlus plan, then the participating providers in LocalPlus will be in-network for those BJC employees with LocalPlus.

It has recently been brought to our attention that our phone carrier is presently having technical issues with some of our Fax lines; they are presently ringing busy.  One of the fax lines that is impacted is our Medicaid medical prior authorization intake line.

If you have a medical prior authorization that you need to fax in, please fax it to: 800-577-1074.

We recognize the inconvenience on you and your office staff, and as we continue to work through this outage, we ask that you also consider leveraging the Availity portal to submit authorizations.

Billing outpatient and inpatient charges update:

Effective November 1, 2022, Healthy Blue will begin to implement billing edits that will now require outpatient services rendered prior to an inpatient admit, to be billed separately from the inpatient charges. All outpatient services should be submitted on one claim while all inpatient services should be submitted on a separate claim.

Any claims received not following the guidance provided will result in a rejected claim. This notification is to provide advance notice on this policy change to allow time for you to make the necessary system updates.

If you have questions about this communication or need assistance with any other item, contact your assigned Provider Experience consultant or call Provider Services at 833-405-9086.

Connecting Evernorth and our Behavioral Health Care Providers

• The loneliness epidemic persists among adults
• Teen mental health takes toll on parents at work
• COVID-19: Interim guidance for behavioral providers
• Medicare Advantage growth offers more practice opportunities
• CAA and keeping your patients informed
• Digital solutions: Procedure code benefit lookup for PPO policies
• Frequently asked questions: EAP administration
• Cigna + Oscar Health plans

See bulletin attached for more details.Evernorth- July 2022 Bulletin

Extension of public health emergency period:

To align with the recent extension of the federal public health emergency (PHE) period, we are again extending the cost-share waiver for diagnostic COVID-19 testing and testing-related services through October 13, 2022 for individuals with Cigna commercial and Cigna Medicare Advantage benefit plans.

See bulletin attached for more details.

Cigna – Covid 19 Update- Public health emergency period extended through Oct. 13 2022

This month’s featured articles:

Administrative:

• AIM Specialty Health phone number update
• Update: outpatient prepay itemized bill review program
• New patient evaluation and management services when reported for the same patient within the last three years
• Timely updates help keep our provider directories current

Digital Tools:

• Add supporting documents directly to your claims with the new Claims Status Send Attachments feature
• Introducing the Provider Learning Hub

Behavioral Health:

• Telehealth visits can impact after-hospitalization follow-up care for mental illness

Pharmacy:

• Specialty pharmacy updates – August 2022
• Pharmacy information available at anthem.com

Medicare:

• Keep up with Medicare News – August 2022

Anthem Provider Newsletter – Missouri August 2022

General New

• Medica’s 2021 annual report now available by following this link: 2022 Medica Annual Report

Clinical News

• Medical policies and clinical guidelines to be updated – Effective September 19, 2022: Updates to Medical Policies

Pharmacy News

• A link to the latest Summary of Changes is included:  Summary of Changes
• Medica to add new UM policies for 2 new medical pharmacy Drugs – Effective August 1, 2022 -J0172 Aduhelm and J3590 Fylnetra
• Medica to implement 2 new drug coverage policies – J0172 Aduhelm, J3285 Remodulin – Effective 09/22/2022
• Upcoming changes to Medica Part D drug formularies – Effective August 1, 2022

Network News

• Effective 10/01/2022 Medica will implement standard ancillary fee schedule updates for all Medica products. This will impact several areas and these can be viewed by following the link to the newsletter.

Administrative News

• Provider administrative training webinar for August: Claim Appeals, Adjustments and Record Submission.  View the newsletter for details.

Medica August 2022 Newsletter

This Quarter’s Featured Articles:

FEATURE ARTICLE

• Virtual care services should now be billed with POS code 02

POLICY UPDATES

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

ELECTRONIC TOOLS

• Register to receive InstaMed patient payments
• Save time: Submit reconsideration requests and appeals online
• Forgot your CignaforHCP.com user ID or password?
• Tips for online reconsideration and appeals
• Webinar schedule for digital solutions

CONNECTED CARE

• Timely referrals: The important role of PCPs
• Tips for rescheduling patient appointments

NETWORK UPDATES

• Cigna + Oscar Health plans
• Cigna Gene Therapy Program updates
• CLINICAL NEWS
• Providers are critical in maternal mental health screening

PHARMACY NEWS

• Accredo Wellbeing Watch supports patients with depression and anxiety
• Specialty Medical Injectables with Reimbursement Restriction

MEDICARE NEWS

• 2022 Cigna Medicare Advantage plan highlights
• Cigna Medicare Advantage COVID-19 updates
• Bridging the Part D coverage gap
• Extending your treatment plan for Medicare Advantage patients

GENERAL NEWS

• Physician quality and cost-efficiency reconsideration requests due September 9
• Ambulatory medical record review provider follow up
• Healthmap Solutions: Enhanced support for chronic kidney disease
• Order hearing devices from Amplifon, our exclusive national provider
• Coordination of care
• Industry insights: Navigating the transition to value-based care
• Cigna quality resources and more
• Social determinants of health CME training and resources
• Medical record requests: Thank you for responding
• Discounts for language assistance services

REGIONAL NEWS

• Quarterly notification of Maryland nonparticipating specialists
• California language assistance law
• New Mexico language assistance law

HELPFUL REMINDERS

• Market Medical Executives contact information
• How to contact us
• Updated reference guides and manuals
• 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? ……….42
• Get digital access to important information
• Access the archives
• Letters to the editor

Cigna Network News 3rd Quarter 2022

Effective October 15, 2022, Cigna will update their medical coverage and reimbursement policy related to physical therapy, occupational therapy and chiropractic services as follows:

• Physical therapy, occupational therapy, and chiropractic claims for greater than four units (60 minutes) of timed service

The portion of a physical therapy (PT), occupational therapy (OT), or chiropractic claim that is greater than four units (60 minutes) of timed, short-term rehabilitation services per patient, per day, per provider will be denied as being not medically necessary.

• Modifiers CO and CQ reimbursement reduction for physical or occupational therapy assistant services

Reimbursement for claims submitted with modifiers CO and CQ for services provided by a physical therapy (PT) or occupational therapy (OT) assistant will be reduced by 15 percent. This update more closely aligns with industry standards, including the CMS National Physician Fee Schedule, which reimburses these services at 85 percent.

Click the following link to view the complete announcement from Cigna.

Cigna – Reimbursement Policy – PT OT Chiropractic Services 101522