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 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 via I Need To… ǀ Providers ǀ Mercy Provider and Payor Networks | Mercy Provider Network. Please include a W-9 Form if the change involves a new billing address or tax identification number.

Payor Resource Links

The below grid contains resource links to payers Mercy is contracted with.  It contains quick access to the payor websites and provider manuals for each our payors. *** Please login to your provider Contract Matrix here: Health Plans | Mercy Provider Network to see a current health plan list for a breakdown of all contracted payors, products, and network names that your practice opted into for participation.***

Payor Resource Links 2026

Effective March 18, 2026, providers will no longer be able to submit claims for patients with HealthSpring Medicare Advantage coverage via the Cigna Medicare Enterprise Gateway. If a claim is submitted via the Cigna Medicare Enterprise Gateway, then the claim will be rejected for member not found.

To prevent delays in claims processing, providers should contact their respective clearinghouse or claims submission vendor before March 18 to ensure they are configured correctly. All clearinghouses should use payer ID 52192 for HealthSpring Medicare Advantage claims. Providers who submit claims via the provider portal, Availity® Essentials, should access the HealthSpring Medicare Advantage payer space and use the payer ID 52192.

Gateway Claims Change | HealthSpring for Providers | HealthSpring

Attention: Mercy Network LLC Practice Managers

Please share with appropriate office staff

Attached is the Mercy Managed Care Q2 FY2026 Bulletin.

Mercy Clinic Managed Care Bulletin – Affiliate_02.06.26 FINAL

Timely Submission of Authorization Requests

As a reminder, certain services require prior authorization before the services are fully furnished. Contract providers must timely submit an authorization request when required. Please see Humana’s Prior Authorization and Notification List (PAL) and Provider Manual for details.

Based on recent CMS guidance, requests submitted after services are fully furnished must be processed as payment requests. Accordingly, providers should submit a claim after the services have been fully furnished – not a request for authorization (retro authorizations).

Please see Humana’s Prior Authorization and Notification List (PAL) and the Provider Manual for details on the services that require prior authorization.

If providers have questions, they can contact Humana at 800-457-4708.