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 Important reminder: New ID cards for many of our Anthem Blue Cross and Blue Shield members

January 20, 2023

Many members received new ID cards with a new ID and new group number.

Be sure to request these new ID cards from our members to update your records with this
new member information.

This new ID number is required to verify eligibility and benefits.

Through our secure portal Availity.com*, you can easily get answers to your questions
about, claim status, eligibility, and benefits. You can also retrieve electronic remits, make
provider demographic changes, and complete your pre-authorization inquiries.

If you are not an Availity user, visit www.availity.com to register today. It’s safe, secure,
and easy to use!

To contact our Provider Service team, please call the Provider Service toll free number
located on the back of the member’s new ID card.

Anthem Reminder – New ID Cards for 2023

Anthem Provider Newsletter – January, 2023

January 03, 2023

Anthem Provider Newsletter – Missouri January 2023

This month’s featured articles:

Administrative:

  • Professional system updates for 2023
  • Outpatient system updates for 2023
  • Notification regarding reimbursement changes to COVID-19 laboratory services codes
  • Engagement with your patient counts
  • Childhood Immunization Status and Lead Screening in Children for HEDIS
  • Remittance advice message enhancements: Providing clear descriptions and actionable next steps

Digital Tools:

  • Submitting prior authorizations digitally through Interactive Care Reviewer

Reimbursement Policies:

  • Outpatient facility revenue code billing requirements

Medical Policy & Clinical Guidelines:

  • Updates to AIM Specialty Health Rehabilitative and Habilitative Services Clinical Appropriateness Guidelines
  • Update: AIM Specialty Health Cardiology Clinical Appropriateness Guidelines CPT Code List
  • AIM Specialty Health Cardiology Clinical Appropriateness Guidelines CPT code list update
  • Updates to AIM Specialty Health Radiation Oncology Clinical Appropriateness Guidelines
  • Updates to AIM Specialty Health Musculoskeletal – Interventional Pain Management Clinical Appropriateness Guidelines
  • Updates to AIM Specialty Health Cardiac Clinical Appropriateness Guidelines – Material adverse change

Pharmacy:

  • Specialty pharmacy updates

Medicare:

  • Keep up with Medicare news – January 2023
  • Cleveland-Cliffs offers Medicare Advantage option

Federal Employee Plan (FEP):

  • Federal Employee Program observation conversion for musculoskeletal cases