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.

Are you a new provider or need a Healthy Blue website refresher? Attend an upcoming virtual provider website training.

Our Missouri Provider Experience team will lead monthly reoccurring interactive training sessions the second Wednesday of each month from 12:30 to 1 p.m.

To register, please send an email to with the required info at least 48 hours prior to the scheduled session.

Healthy Blue- Provider Portal training and refresher

We’ve attached a reminder from Healthy Blue that the claims runout for Missouri Care claims ends on 06/30/2022.  Keep in mind that after that date Managed Care will be unable to assist with any outstanding claims that may exist.

In January 2020, Anthem, Inc. acquired the WellCare/Missouri care health plan, and with that acquisition, WellCare put in place an agreed upon claims runout review period of 18 months. With the 18 month runout timeframe, providers were provided a window from 1/1/2021-6/30/2022 to rectify all outstanding WellCare claims.

This email serves as a friendly reminder that the window for review of WellCare claims will close EOD on 6/30/2022, and there will no longer be an opportunity to have outstanding WellCare A/R reviewed. Please work with your billing team to ensure that they have submitted all outstanding A/R, that would comply with the dispute timely filing requirements under your WellCare/Missouri care agreement, to the run out mailbox here .

Reminder- All submissions must be placed on the WellCare claims spreadsheet and accompany the required provider contact sheet. Please outreach to your PR rep if you would like a copy of those required documents.

In October 2020, California enacted Senate Bill 221, which requires health plans and insurers to provide customers with timely care for mental health issues and substance use disorders.

In compliance with this law, effective July 1, 2022, appointment availability requirements for mental health and substance use services rendered by Evernorth Behavioral Health network-participating providers will be as follows:

For complete information, please access the full article by clicking the following link.

Evernorth Appointment Availability Requirements

National Imaging Associates, Inc. (NIA) provides utilization management services for non-emergent, Medical Specialty Solutions for Home State Health. In the interest of streamlining authorization processes and improving member outcomes, Home State Health has expanded its partnership with NIA.

Effective September 1, 2022, the prior authorization program with NIA will be expanded to include the following non-emergent outpatient Medical Specialty Solution procedure:

• CPT Code 74263 – Screening CT Colonoscopy (Virtual Colonoscopy, CT Colonography)

For more information, please access the following link for the complete article.

home state prior authorization notice 090122

This month’s featured articles:

Administrative:

• Provider outreach to validate your provider data
• Forum: Exploring the Intersection of Race and Disability
• Once-a-year testing is critically important to providing quality diabetes care
• CAA: Provider directories accuracy is important

Products & Programs:

• Updates to AIM musculoskeletal program: Monitored anesthesia care reviews
• Updates to AIM musculoskeletal program: Site of care reviews

Behavioral Health:

• Opioid overdose deaths: What can we do?

Pharmacy:

• Specialty pharmacy updates – June 2022

Medical Policy & Clinical Guidelines:

• Medical policy and clinical guideline updates – June 2022
• Updated guidance on prior authorization requirements for admissions to in-network long-term acute care hospitals (LTACHs)
• Updates to AIM musculoskeletal clinical appropriateness guidelines
• Updates to AIM advanced imaging clinical appropriateness guidelines
• Updates to AIM sleep disorder management clinical appropriateness guidelines

Reimbursement Policies:

• Reimbursement policy update: Treatment Rooms with Office Evaluation and Management Services – Facility

Federal Employee Plan (FEP):

• Process change for Federal Employee Program third-party correspondence requests

Medicare:

• Keep up with Medicare News – June 2022
• Evaluation and management services for COVID testing – professional
• Authorizations for post-acute care services for Medicare Advantage individual, Group Retiree Solutions (GRS), and Dual-Eligible Plan members
• Medical drug benefit clinical criteria updates
• Medical policies and clinical utilization management guidelines update
• Updates to AIM Specialty Health advanced imaging clinical appropriateness guidelines

Anthem Provider Newsletter – Missouri June 2022

Inside this issue: 
– Coming Soon: Annual CAP Publication
– Understanding Provider Directory Requirements
– New Drug Management Program
– BCBSKS Offering License Pharmacists to Join Network
– BCBSKS Providers Billing Immediate Family Member Services
– On the Move in Wichita
– IBEW226 Members
– St. Francis Ministries Benefit Information
– Behavioral Health Workshop

BCBS Kansas – Professional Provider Report 052722

Cigna has issued the attached update addressing the current global supply chain shortage of the intravenous contrast solution used in computed tomography imaging.

Contrast shortage update – May 2022

2022 Spring Issue Network News (oklahoma.gov)

• Codes Requiring Review – On occasion, HealthChoice will identify certain claims or codes for review and will request medical records for these claims prior to issuing payment.  This helps ensure that claims meet medical necessity requirements and standards of care.
• ABA plan limitations removed from HealthChoice
• Certification and claim appeals for medical and dental services – Beginning October 1, 2022 providers can appeal any claim that was denied in whole or in part by submitting a letter to the claims administrator at the designated address within 180 days of receipt of denial.
• Timely filing and appeal deadlines for medical and dental claims – Effective July 1, 2022:
  • Corrected claim submissions must be filed within 180 days from the original processed date.
  • Secondary and tertiary claim submissions must be filed within 180 days from the previous responsible carrier’s processed date.
  • Any medical or dental certification request denied in whole or in part can be appealed within 180 days from receipt of denial.
• Fee schedule updates  <- Click link for schedule of releases and additional information.  Next update is July 1, 2022.
• Contact information <- Click link

In this issue

• Codes requiring review
• ABA plan limitations removed from HealthChoice
• Certification and claim appeals for medical and dental services
• Timely filing and appeal deadlines for medical and dental claims
• Fee schedule updates
• Contact information

Please remember that Mercy providers are only contracted with HealthChoice in the following areas:  Missouri – Joplin and Carthage  Kansas – Columbus and Galena.

Network News Spring 2022

Included in the most recent UHC Network News is a reminder that all updates can be reviewed by following the link at the bottom of the page.  These are divided into the four categories below:

• Policy and Protocol
• Medical Policy
• Reimbursement Policy
• Prior Authorizations

Effective 06/15/2022 you will no longer be able to access the Provider Portal and UHCprovider.com if you are using Internet Explorer 11.

If you have claims and payment questions you can visit the Payment Accuracy page.  You’ll find links to Smart Edits, coding and updates to Reimbursement Policies.

United Healthcare Network News