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.

Cigna for HCP Update April 2023

Beginning April 27, 2023, the “Am I In Network” tool on the Cigna for Health Care Professionals website (CignaforHCP.com) will be moved to the top of the Patient Plan and Detail screen, and will appear as “Network Status.”

Network Status will work the same as the “Am I In Network” feature by using the selected Taxpayer Identification Number (TIN) and Provider/Group Name to determine network status for your patients with Cigna Healthcare medical coverage.

Learn more
Please refer to the attached for more details on how to use the new feature, and for answers to frequently asked questions.

We want to hear what you think

We appreciate your ongoing feedback as we continue to make enhancements to CignaforHCP.com. You can submit feedback using the feedback tab located on the right side of the website.

If you have any questions, please send an email to .

Thank you for the care you provide to our customers.

Click on the following links to access the current edition of Cigna Network News

Cigna Network News 2nd Quarter 2023

HealthChoice Network News Spring 2023

In this issue

• Faxed certification requests are no longer accepted
• Provider appeals
• Network Management contact information update
• Billing with the rendering provider
• Fee schedule updates
• HealthChoice contact information

Please review the following information received from Cigna.

Since the COVID-19 pandemic began, we have taken important steps to deliver timely accommodations to providers and customers, helping to ensure that customers have continued access to COVID-19 diagnostic services, testing, and treatment in safe settings.

Ending the public health emergency period

As you know, the White House announced their intent to end both the COVID-19 national emergency and public health emergency (PHE) on May 11, 2023.

As a result, Cigna commercial and Cigna Medicare Advantage plan to make the following changes on May 12, 2023:

• Authorizations for facility-to-facility transfers will again be required.
• Patient cost-share will apply to COVID-19 lab tests as well as antiviral and therapeutics approved by the U.S Food & Drug Administration (FDA).
• For most benefit plans, COVID-19 vaccines will be covered at 100 percent under the preventive benefit (same as the flu shot) when customers go to an in-network provider.
• Over-the-counter COVID-19 tests will no longer be covered.

Please know that we continue to monitor for any updates from the administration and continue to evaluate potential additional changes to our ongoing COVID-19 accommodations as a result of the PHE ending.

Home State Health offers some helpful links to better equip your practice.  Please click on the following link to view their information.

Home State Health – Important Provider Tips 041323

Since the COVID-19 pandemic began, we have taken important steps to deliver timely accommodations to providers and customers, helping to ensure that customers have continued access to COVID-19 diagnostic services, testing, and treatment in safe settings.

Ending the public health emergency period

As you are likely aware, the White House recently announced their intent to end both the COVID-19 national emergency and public health emergency (PHE) on May 11, 2023.

As a result, Cigna commercial and Cigna Medicare Advantage intend to extend its cost-share waiver for diagnostic COVID-19 tests and related office visits through at least May 11, 2023, subject to any further announcements or guidance from the administration.

We also continue to evaluate any potential changes to our other ongoing COVID-19 accommodations in preparation for the end of the PHE.

Get all the most up-to-date information

Our dedicated COVID-19 provider web page will be updated in the coming days to highlight the end date of the PHE and to note that we will share additional information soon.

Cigna – Reimbursement Policy Update – E&M Codes Billed with Injection Admin and Testosterone Drug Codes 041623

• We will deny evaluation and management (E&M) Current Procedural Terminology (CPT®) codes 99211-99215 billed with CPT code 96372 and Healthcare Common Procedure Coding System (HCPCS) codes J1071 or J3145 by the same provider on the same claim, for the same date of service, and when there are no other services billed on the claim.
• Only the E&M codes on the claim will be denied.
• This update is effective for dates of service on or after April 16, 2023.

Anthem Provider Newsletter – Missouri February 2023

This month’s featured articles

Administrative:

• Controlling High Blood Pressure and Submitting Compliant Readings
• AIM Specialty Health will transition to Carelon Medical Benefits Management Inc.
• Have you reviewed your online provider directory information lately?
• Do you offer telehealth services? Let us know!

Digital Tools:

• Enhancing Provider News website and email communications
• Helping to reduce delays when submitting attachments: Make sure your correspondence includes one of these elements

Medical Policy & Clinical Guidelines:

• Medical Policies and Clinical Guidelines updates – February 2023
• AIM Specialty Health Cardiology Clinical Appropriateness Guidelines CPT Code List update
• Updates to AIM Specialty Health Advanced Imaging Clinical Appropriateness Guidelines

Pharmacy:

• Specialty pharmacy updates – February 2023

Federal Employee Plan (FEP):

• 2023 FEP benefit information available online

Medicare:

• Name change announcement: myNEXUS will transition to Carelon Post Acute Solutions on March 1, 2023
• Keep up with Medicare News – February 2023

HealthChoice Network News Winter 2023

In this issue

• Department of Corrections billing update
• Faxed certification requests are no longer accepted
• Electronic Funds Transfer
• Dental pre-determinations
• Dental maximum benefit
• Certification penalties
• Outpatient Reimbursement Methodology
• Copays for primary care and specialists
• Enhanced portal features for HealthChoice
• Fee schedule updates
• HealthChoice contact information

Cigna – Coverage Policy Update – Peripheral Nerve Block Procedures 041623

Cigna routinely reviews their coverage, reimbursement, and administrative
policies for potential updates.  As a result of a recent review, they implement the following medical coverage policy updates.

• We will deny claims for peripheral nerve block procedures billed with Current Procedural Terminology (CPT®) codes 64505, 64400, and 64405 as experimental, investigational, or unproven (EIU) regardless of the diagnosis.
• CPT code 64450 will be denied as EIU only when submitted with a headache and/or trigeminal/occipital neuralgia diagnosis.
• This update is effective for dates of service on or after April 16, 2023.