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 review this announcement for information on upcoming registrations for the month of August.  .

Upcoming webinars and the accompanying registration links are listed below. Registration is on a first come first serve basis. If you are unable to attend, the recorded webinars and related PowerPoint presentations will be posted here.

EXCLUSIVE TRAININGS FOR AUGUST

The following trainings have been offered by Beacon in the past, but do not occur on a monthly basis. If you haven’t had the chance to participate and have been wanting to, now is your time! Register before it’s too late!

Behavioral Health 101: A high-level overview of behavioral health definitions and practices. Training will define common behavioral health diagnoses like Bipolar, Schizophrenia, Major Depressive Disorders, and will provide statistics, background, common signs and symptoms associated

August 3 at 3 PM EST

Registration Link

Follow Up After Hospitalization/HEDIS Measure Overview: webinar will cover HEDIS measures for follow up after hospitalizations.

August 18 at 3 PM EST

Registration Link

Potential Quality of Care/Serious Reportable Events: webinar covers Potential Quality of Care (PQOC) concerns, including Serious Reportable Events (SREs) and reporting to Beacon Health Options.

August 18 at 4 PM EST

Registration Link

Dual Diagnosis: An introductory level training on Dual Diagnosis: the co-occurrence of substance use disorders and mental health disorders. This 1.5 hour course will cover definitions, statistics and warning signs of substance use and mental health disorders, as well as discuss potential causes and effects. It will also explore various treatment considerations including the importance of integrated screening and treatment. There is no CE credit or certification associated with this training.

August 24 at 3 PM EST

Registration Link

ProviderConnect Authorizations: This webinar is designed for providers and office staff who submit authorizations through ProviderConnect

August 31 at 2 PM

Registration Link

REOCCURING MONTHLY WEBINARS 

Claims Submission Guidelines: This live training provides an overview of billing and claims information and how to submit claims to Beacon Health Options along with reviewing best practices and avoiding claim denials.

August 10 at 2 PM EST

Registration Link

eServices Overview: webinar designed to provide an introduction and overview of the eServices platform for those health plans that use this portal. Topics covered include how to register, use, and submit claims and authorizations via eServices.

August 17 at 2 PM EST

Registration Link

ProviderConnect Overview: This webinar is intended for providers and office staff becoming familiar with ProviderConnect for the first time.

August 24 at 2 PM EST

Registration Link

InterQual for Providers: An overview of how to view and access Beacon’s Medical Necessity Criteria via InterQual.

August 25 at 1 PM EST

Registration Link

These webinars will be recorded and posted to Beacon Health Options Recorded Webinars if you are unable to attend the live session.

Please see the announcement from Optum Behavioral Health.

On August 1, 2022, the telehealth flexibility period will end for Applied Behavior Analysis (ABA) services for Commercial membership and for Medicaid membership, if no state mandate was issued (state mandates take precedence).

The following services for which in-person care is evidence-based will no longer be covered when provided in a virtual modality:

• Applied Behavior Analysis (ABA) service codes 97151, 97152, 97153, 97154, 97158, O362T, O373T presented virtually

Existing ABA caregiver training and technician supervision will continue to be permitted virtually for service codes: 97155, 97156, 97157.

Please refer to providerexpress for our ABA telehealth policy updates and FAQ’s.

We greatly value your participation in our network and thank you for the care you provide to members served by Optum.  Should you have any questions, please contact the Provider Service Line at 1-877-614-0484.

Cigna recently announced an update regarding reimbursement for claims submitted with evaluation and management (E&M) Current Procedural Terminology (CPT®) codes
99212, 99213, 99214, and 99215 and modifier 25 when a minor procedure is billed.

They are currently reevaluating this reimbursement policy change, which will delay implementation.  Therefore, this policy will not go into effect on August 13, 2022, as originally planned.  They will communicate a new implementation and and details after their internal evaluation is complete.

Please click on the following link to view the complete announcement.

Cigna Reimbursement Policy Updates – Modifier 25 070622

The July 2022 UHC Kancare Newsletter is available below.

United Healthcare Community Plan of KS updates

TrackIt – a daily to-do list for your UHC claim related tasks.

TrackIt is an innovative tool on the UnitedHealthcare Provider Portal landing page that serves as your daily to-do list, your personal assistant, and an automatic reminder for all your UnitedHealthcare claim related tasks.

Need to upload a document? Are we missing some information to process your claim? TrackIt will tell you. No need to pick up the phone or wait for the mail. You can complete many actions without leaving the tool. TrackIt allows you to find information faster, save clicks and reduce unnecessary searches.

Make your workday more efficient and save time by checking TrackIt daily.

TrackIt ‒ A daily to-do list for your UnitedHealthcare claim-related tasks | UHCprovider.com

Spotlight on Common Denials

In this segment, we will discuss some of the most common denial reasons and provide tips to effectively reduce them.

Oddly enough, the most common denial we see as a payer, is the easiest to avoid. The most common denial across all provider types is CO-18: Duplicate claim/service. This happens when the claim is resubmitted without follow up.

How to avoid Duplicate denials:

• Allow 30 calendar days from the receipt date for the claim to process
• Check claim status before submitting another claim
  • Phone – UHC Provider Services: 1-877-542-9235
  • Online – UHC Secure Provider Portal: UHCProvider.com
    • Training opportunities mentioned in next section
  • Review EDI reports to verify which claims were received and accepted or rejected
    • Check with your clearinghouse if not familiar with these reports

Upcoming UHC-Kancare Training Opportunities

If you’re not familiar with UHC’s Provider Portal – there are 2 training methodologies to help you become proficient:

Instructor-led – Instructor-Led Learning Events | UHCprovider.com

Look for course entitled: Claims Overview

Self-paced – Digital Solutions | UHCprovider.com

Look for course entitled: Claim Follow Up Self-Paced User Guide

Kancare UHC 101 (Medicaid 101) is held the last Wednesday of every month from 11am – noon CST

This month’s webinar will be held on July 27^th at 11:00am CST

Webinars are hosted by Mona Hull

• • • Join the Microsoft Teams meeting  : Click Here to Join the Meeting
    • Call-In (Audio Only) : +1 952-222-7450
    • Phone Conference ID : 555 098 422

KMAP News

Attention Ambulance Providers – Effective with dates of service on and after July 1, 2022, a new rate increase will be available for certain services. See KMAP Bulletin 22105 for more details.

Attention Behavioral Health Providers – Effective with dates of service on and after July 1, 2022, certain Behavioral Health Services (BHS) codes will have a rate increase. See KMAP Bulletin 22128 for full details.

The KMAP Coding Modifiers Table was last modified on June 28, 2022. This chart has been developed to assist providers in understanding how KMAP handles specific modifiers. It is imperative providers understand the importance of using these modifiers correctly. Improper coding could result in a delayed, denied, or incorrect payment for the service(s) submitted. United Healthcare Community Plan of Kansas is obligated to follow KMAP’s direction with regards to modifier usage.

Recent KMAP Bulletins

For a complete listing of bulletins, please reference KMAP Provider Bulletins

July bulletins

• 7/8 – Bulletin 22148 – Preferred Drug List Update
• 7/7 – Bulletin 22128 – Updated – Behavioral Health Services Rate Increase

June bulletins

• 6/29 – Bulletin 22141 – Pregnant Woman Postpartum Coverage Extension
• 6/27 – Bulletin 22129 – Services Performed by Temporarily Licensed SLPs Code Update
• 6/27 – Bulletin 22105 – Ambulance Service and Ground Mileage Rate Increase Update
• 6/15 – Bulletin 22119 – COVID-19 Testing for Same Date of Service
• 6/10 – Bulletin 22120 – Annual DME Rate Adjustment

Healthy Blue Medicaid has provided this attachment which contains several phone numbers and links that will help you find the information you’re needing.  Also included on the attachment is the contact information for Barbara Wheeler who is the Behavioral Health Provider Experience Consultant.  Feel free to contact her with any behavioral health issues or concerns.

Healthy Blue Medicaid Contact Numbers

UHC Community Plan of Missouri has upcoming changes beginning 8/1/22 related to OB services.  The UHC provider advocate team wanted to host a learning session to review the upcoming changes and also provide information on Wellhop for Mom & Baby.

There are three meeting times available:  Wednesday July 20^th 12:00 – 12:30 pm, Friday July 22^nd 12:00 – 12:30 pm or Wednesday July 27^th 9:00 – 9:30 am.  The meeting links are below.

Missouri: CPT® code changes for obstetrical services beginning Aug. 1, 2022 | UHCprovider.com

UHC MO Community Plan Wellhop Provider FAQ

Microsoft Teams meeting

Join on your computer or mobile app

Wednesday July 20^th 12:00 – 12:30

Click here to join meeting

Friday July 22^nd 12:00 – 12:30

Click here to join meeting

Wednesday July 27^th  9:00 – 9:30

Click here to join meeting

Or join by entering a meeting ID
Meeting ID: 275 986 651 015
Passcode: wpDuiz

Join with a video conferencing device

Video Conference ID: 115 235 792 28

Alternate VTC instructions

Or call in (audio only)

+1 952-222-7450,,188302057#   United States, Bloomington

Phone Conference ID: 188 302 057#

Find a local number | Reset PIN

Effective October 1, 2022, Cigna will expand their prior authorization requirements for certain oncology drugs to include a medical necessity review of the site of care.  This expansion will help to ensure appropriate coverage for patients who have Cigna coverage.  The list of affected drugs is included on the Cigna Specialty Care Options and Cigna Specialty Care Options Plus flyer.

For more information, please review the attached announcement from Cigna along with a copy of the Cigna Specialty Care Options and Cigna Specialty Care Options Plus flyer.

Cigna – Authorization Update – Site of Care for Oncology Products

cigna specialty_care_options

The July edition of the Healthy Blue Medicaid Provider News is available by following the link below

July 2022 Provider Newletter

A brief overview of the topics covered

• Additional COVID-19 updates
• Update use of Modifier 25 for billing for visits that include preventive services and problem-oriented evaluation and management services
• Prior authorization requirement changes
• Medical Clinical Guidance (MCG) 26^th edition available for reivew

Cigna has released the attached announcement regarding COVID 19 updates about virtual care.

Cigna – COVID 19 Updates July 1, 2022

This month’s featured articles:

Administrative:

• Introducing Elevance Health — Focusing on whole health and its most powerful drivers
• Updates to edits associated with implants
• Update to facility editing: HCPCS code G0463
• Coding tips for reporting administration of Spravato®
• Help patients heal from the comfort of home with Hospital in Home care
• CAA: Keep your provider directory information current
• More potato chips, sugary drinks and less physical activity are key contributors to childhood obesity
• Clearing up coding confusion for diabetic retinal screenings

Digital Tools:

• Coming soon: The Anthem Provider Learning Hub makes Availity learning easier
• Enhancing claims attachment processes through the digital application Claims Status Inquiry

Products & Programs:

• Enhanced reimbursement for voluntary Cancer Care Quality program to be discontinued effective December 31, 2022

Pharmacy:

• Pharmacy information available at anthem.com

Reimbursement Policies:

• New reimbursement policy: Transitional Care Management – professional
• New reimbursement policy: Modifier FB – Professional and Facility
• Reimbursement policy update: Modifier Rules – Professional
• Reimbursement policy update: Laboratory and venipuncture services – professional and facility Retraction for reimbursement policy: Sexually Transmitted Infections – Professional
• Reimbursement policy update: Distinct Procedural Service, Modifiers 59, XE, XP, XS, XU – professional

Medicare:

• Keep up with Medicare News – July 2022
• Update use of Modifier 25 for billing for visits that include preventive services and problem-oriented evaluation and management services
• Cancer Care Navigator

Anthem Provider Newsletter – Missouri July, 2022