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.

NHC Advantage Updates – January 2024

As part of our ongoing commitment to simplify and improve payment transactions for your business, NHC Advantage is offering more choice in payment methods.  Recent feedback from our network indicates quicker reimbursement and more efficient payment reconciliation are high priorities for our providers, and we’re excited to offer additional payment solutions.

January 2024, NHC Advantage will partner with Change Healthcare and ECHO Health, Inc. to provide these new electronic methods. Many of our providers already work with Change Healthcare today.

Please click on the attachment to review these new payment options as well as an announcement regarding an upcoming System Migration.

The January 2024 Providers Newsletter for Healthy Blue Medicaid is now available to view.  The full newsletter can be viewed by following the link below.

This month features a review of some of the digital tools they offer and a review of Provider Pathways.  Also featured is a review of prior authorization requirements that go into effect 03/01/2024 for codes J1411, 20979, A7025, E0692 and E0693.

2024 Provider Newsletter

Healthy Blue newsletter – Jan 2024

Cigna Healthcare continues to leverage the power of technology and data to accelerate its transition to fully adopt digital-only ID cards by 2025. This approach to digital ID cards is next step in our journey to offer more digital-first solutions for our customers and providers.

What this means to you
Digital ID cards are not new for Cigna Healthcare or the industry overall. Over the past several years, you may have noticed patients starting to present their ID cards to you in a digital format – typically on their phone from the myCigna® app or from the myCigna.com® website. This experience for you and your front-office staff should not change.

However, you may start to see more patients who have a digital-only ID card. As they do today, your patients will have the option to:

• Share their digital ID card image on a phone screen in the office
• Relay the information verbally over the phone to pre-register for their appointment
• Upload the digital ID card image to your health portal
• Email the digital ID card image directly to your office from the myCigna app
• Print a copy of their digital ID card and share it with your office

Importantly, please note the digital ID card will look the same as the physical ID card does today and will contain the same benefit information.

Supporting you through this transition
We understand that providers are at varying stages of readiness to accept digital ID cards, and we are committed to making this transition as smooth as possible for you and your office staff.

Please visit our dedicated digital ID card provider website, CignaforHCP.com/DigitalIDCards, which includes a toolkit of information to answer all of your questions on topics such as:

• Verifying benefits and eligibility
• Accessing a patient’s digital ID card
• Procedure code look-up
• Supporting patient communications and guidance

Cigna Healthcare to launch digital Provider Newsroom in 2024

In early 2024, Cigna Healthcare will launch a web-based Provider Newsroom for health care providers. It will offer intuitive navigation with 24/7 access to timely updates that are important to your practice.

The newsroom will give you a single source of news for many of our lines of business, including commercial medical, Medicare Advantage, and behavioral health. In addition, it will replace existing newsletters for each of these areas, including Network News, Network Insider, and Transformations, respectively.

In the newsroom, you will find up-to-date information on a variety of topics impacting your practice, such as:

• Policy updates
• Health plan and network updates
• Digital tools and trainings
• Industry news
• And more

You will continue to access the Cigna for Health Care Professionals website (CignaforHCP.com) for routine day-to-day business processes, including checking benefits and eligibility, requesting claim reconsideration, and enrolling in and managing electronic funds transfer.

Watch for updates

We will continue to send you emails with additional information about the digital Provider Newsroom, how to access it, when it will launch, and more.

If you have any questions about Cigna Healthcare’s digital Provider Newsroom, please contact me directly anytime.

home state health – behavioral health authorization process changes

BEHAVIORAL HEALTH AUTHORIZATION PROCESS CHANGES

Helping you care for your patient’s behavioral health needs is a top priority

Home State Health supports the timely completion of medical necessity reviews to support high quality outcomes for our members. Providers may submit requests for services through our Secure Provider Portal or fax. To improve the efficiency of the authorization process, we moved to a standardized fax document for authorization requests.

There will be one form for Inpatient Authorization requests and a second for Outpatient Authorizations that support both Behavioral Health as well as Physical Health authorizations. Through use of standardized forms, we reduce the number of separate forms for treatment requests and enhance the flexibility for the providers in the format of their clinical information. Guidelines on the clinical information needed for each behavioral health service type are available on our OTR Completion Tip Sheet.
Our provider website contains the new standardized forms in the Provider Resources section of our website: homestatehealth.com/providers/behavioral-health.

If you have additional questions or need specific support, please see the homestatehealth.com/providers/tools-resources section of our website or call Provider Services: 1-855-694-4663.

PHONE:  Inpatient Authorization requests:  1-855-694-4663
FAX:        Inpatient Authorization fax:  1-833-405-3826

PHONE:  Outpatient Authorization requests:  1-855-694-4663
FAX:        Outpatient Authorization fax:  1-833-405-3827

Anthem Provider Newsletter – Missouri January 2024

This month’s featured articles:

Administrative

• Introducing Paytient: a new interest-free way for your patients to pay for out-of-pocket costs
• Inappropriate primary diagnosis
• CAA: Maintain your online provider directory information
• Important Changes for Active Members of Northrop Grumman Corporation
• Using and billing air ambulance services appropriately

Digital Tools

• Training for digital requests for additional information (Digital RFAI)

Education and Training

• Important information about your Anthem patients’ specialty prescriptions

Medical Policy & Clinical Guidelines | Medicare Advantage

• Clinical Criteriaupdates — August 2023
• Genetic testing code list update

Medical Policy & Clinical Guidelines | Commercial / Medicare Advantage

• Updates to Carelon Medical Benefits Management, Inc. Clinical Appropriateness Guidelines
• Transition to Carelon Medical Benefits Management, Inc. cardiology guidelines

Medical Policy & Clinical Guidelines | Commercial |

• Carelon Medical Benefits Management, Inc. genetic testing CPT^®code list update

Prior Authorization | Commercial |

• Expansion of Carelon Medical Benefits Management, Inc. programs effective April 1, 2024

Prior Authorization | Medicare Advantage |

• Expansion of Carelon Medical Benefits Management, Inc. programs effective April 1, 2024

Dental | Commercial

• January Dental newsletter communications

Pharmacy | Commercial

• Specialty pharmacy updates — January 2024

Quality Management | Medicare Advantage

• Boost annual planned visit rates

Quality Management | Commercial / Medicare Advantage

• HEDIS diabetes documentation
• Annual preventive care visits