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.

Mercy Managed Care – Q1 FY26 Bulletin

October 01, 2025

Attention: Mercy Network LLC Practice Managers
Please share with appropriate office staff

Attached is the Mercy Managed Care Quarterly Bulletin. Please also find a copy of this bulletin, along with previous versions, listed on the Mercy Provider Network ǀ Health Care Management website under Provider and Payor Networks section here: Provider Contracting News | Mercy Provider Network

If you have any questions, please email

Thanks!

Mercy Clinic Managed Care Bulletin – Affiliate_10.01.25 FINAL

East Community: One Mercy Hospice Go-Live 10/1/2025

September 24, 2025

One Mercy Hospice

Dear Provider Partners,

We are excited to announce that the East community hospice teams will officially consolidate on October 1, 2025, marking a major milestone in our journey toward a unified One Mercy Hospice model.

This transformation is more than operational—it’s deeply personal. By bringing our teams together under one aligned structure, we’re strengthening our commitment to caregiver connection, mission-driven service, and strategic excellence.

Why One Mercy Hospice Matters
• Consistency in Care: Standardized practices across communities ensure every patient receives the same high-quality, compassionate care.
• Empowered Caregivers: Unified teams foster trust, belonging, and shared ownership—creating a culture where caregivers thrive.
• Operational Strength: Streamlined workflows and shared resources improve efficiency and accelerate innovation.

The One Mercy Hospice model embodies these goals by creating a seamless experience for caregivers and patients alike—one that is predictive, proactive, and personalized.

As we move forward, we celebrate the dedication of our hospice teams and leaders who have made this vision a reality. Together, we are building a future where more people choose Mercy for more of their care.

Cigna – Administrative Policy Update – Preventive Care Services

December 20, 2024

Cigna – Admin Policy Update – Preventive Care Services 031725

As a result of a recent review, and in accordance with Affordable Care Act guidelines, coverage for certain services billed as preventive will be subject to criteria including age, frequency, and diagnosis codes. submitted. Based on these factors, we may determine that related claims are not reimbursable, or claims may be reimbursed with the appropriate cost share under the medical benefit.

This update applies to certain claims billed as preventive care for abdominal aortic aneurysm, cervical cancer, colorectal cancer, human papilloma virus, osteoporosis, and lung cancer screenings. We will update the Preventive Care Services (A004) administrative policy to reflect this change,

Denials will affect the claim line only. This update is effective for dates of service on or after March 17, 2025.

Evernorth Behavioral Health – Prior authorization requirements for partial hospitalization level of care effective January 1, 2025

December 09, 2024

EverNorth Behavioral Health Authorization Requements for Partial Hospitalization Level of Care4 010125

Dear Behavioral Health Provider,

Evernorth® Behavioral Health (Evernorth) is committed to helping you deliver timely care to your patients by reducing your administrative burden. Therefore, effective January 1, 2025, we are updating our prior authorization requirements for partial hospitalization (PHP) level of care.

What this means

  • Prior authorization will no longer be required for PHP level of care for your patients with coverage under most Evernorth plans. However, a small number of plans will still require prior authorization.
  • Dates of service prior to January 1, 2025, may require prior authorization.
  • For patients with Cigna Connect IFP plans, services rendered outside of their state of residence are considered out of network. Therefore, always verify benefits, eligibility and prior authorization requirements prior to rendering services. You can easily identify patients with Cigna Connect IFP plans by viewing their ID card, which will indicate the plan name. A Partial Hospitalization (PHP) Network Exception Request Form is now available on Provider.Evernorth.com (Resources > Forms Center > Behavioral Health Forms) to submit a request for prior authorization.

To verify patient benefits, eligibility and prior authorization requirements

Continue to use the same process you use today to verify a patient’s benefit plan details and prior authorization requirements before rendering services.

  • Call Provider Services at 800.926.2273.
  • Log in to the provider portal on Provider.Evernorth.com.
    Register here to access the portal if you have not already registered. The portal provides 24/7 secure access to patient information such as eligibility and benefits, and allows you to check prior authorization requirements, view remittance reports, enroll in electronic funds transfer (EFT), and make directory profile updates.

Assistance with additional resources and discharge planning is available by calling Provider Services at 800.926.2273.

Thank you for your ongoing commitment to provide quality behavioral health services to our customers.

Sincerely,

Network Operations Management
Evernorth Behavioral Health

Summit Community Care Provider Newsletter – December 2024

December 02, 2024

Summit Community Care Provider Newsletter – December 2024

This month’s featured articles:

Administrative

Notice of Material Amendment to Healthcare Contract

Digital Solutions

Education & Training

Policy Updates

Notice of Material Amendment to Healthcare Contract

Notice of Material Amendment to Healthcare Contract

Long-Term Services & Supports

Pharmacy

Notice of Material Amendment to Healthcare Contract

 

Anthem Provider Newsletter – December 2024

December 02, 2024

Anthem Provider Newsletter – Missouri December 2024

This month’s featured articles:

Administrative

Digital Solutions

Behavioral Health

Education & Training

Policy Updates

Reimbursement Policies

Products & Programs

Federal Employee Program (FEP)

Pharmacy

Quality Management

Cigna Healthcare administrative quick tip guide

November 06, 2024

Cigna Healthcare Administrative Quick Tips

To help ease your administrative burden and support you in spending more time your patients, Cigna has developed this administrative quick tip guide. It provides at-a-glance information and resources to help you work with us in the most efficient manner possible. Topics include:

  • Benefits and features of the Cigna for Health Care Professionals website (CignaforHCP.com).
  • Provider Newsroom
  • Credentialing
  • Claim reconsiderations and appeals
  • Claim attachment submissions
  • Claim escalations
  • Third-party administrator claim escalations
  • Cigna International Health claim reconciliation requests

Healthy Blue Provider Newsletter November 2024

November 01, 2024

Healthy Blue Provider Newsletter November 2024

This month’s featured articles:

Administrative

Digital Solutions

Education and Training

Policy Updates 

Medical Policy & Clinical Guidelines

Prior Authorization

Pharmacy

Quality Management 

 

Summit Community Care Newsletter – November 2024

November 01, 2024

Summit Community Care Provider Newsletter – November 2024

This month’s featured articles:

Education and Training

Policy Updates

Notice of Material Amendment to Healthcare Contract

Medical Policy & Clinical Guidelines

Notice of Material Amendment to Healthcare Contract

Prior Authorization

Notice of Material Amendment to Healthcare Contract

Quality Management

Anthem Provider Newsletter – November 2024

November 01, 2024

Anthem Provider Newsletter – Missouri November 2024

This month’s featured articles:

Administrative

Digital Solutions

Behavioral Health

Education and Training

Policy Updates

Reimbursement Policies

Products & Programs

Pharmacy