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.

United Healthcare July Network News

July 01, 2024

The full edition of the July Network News is available by following the link below

United Healthcare July Network News

The link below will allow you to access an overview of all policies updates, mandates, state-specific news, training and more Medicare Advantage, Medicaid and commercial plans.  You also have the option of accessing only Medical policy updates, Reimbursement policy updates, Specialty Medical Injectable Drug updates and Pharmacy and clinical update but following the links provided on the Network News.

July monthly overview | UHCprovider.com

Prior Authorization Updates

  • Medicare: Prior authorization updates for continuous glucose monitors
  • Updates for sacral nerve stimulation for urinary and fecal indications
  • Oncology and hematology prior auth updates effective 10/01/2024

Preferred Lab Network Updates

Prescription Drug List Updates effective 09/01/2024

You will also find a reminder to complete MOC training for Special Needs Plans, a notice that you may be contacted to take part in a Risk Adjustment Data Validation audit program and a link and a reminder that time is running out to take a Network News survey

Free SDOH CME Cours

July 01, 2024

United Healthcare/Optum is offering a free course for providers who are interested in telehealth and how to reduce barriers to it’s use.  This course is open to several specialties such as Pharmacists/Pharmacy Techs, Physicians, Nurses, Psychologists and Social Workers.  The course is scheduled for 07/16 and full details regarding registration, CMEs available, etc can be viewed by following the link below.

Reducing Barriers to Telehealth

Summit Provider Newsletter – July 2024

July 01, 2024

Summit Community Care Provider Newsletter – July 2024

This month’s featured articles:

Administrative

Education and Training

Policy Updates

Notice of Material Amendment to Healthcare Contract

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

Notice of Material Amendment to Healthcare Contract

Pharmacy

Anthem Provider Newsletter – July 2024

July 01, 2024

Anthem Provider Newsletter – Missouri July 2024

This month’s featured articles:

Administrative

Digital Solutions

Education and Training

Policy Updates

Medical Policy & Clinical Guidelines

Prior Authorization

Reimbursement Policies

Federal Employee Program (FEP)

Pharmacy | Commercial

Quality Management

 

July 2024 Medica Connections

June 18, 2024

Medica Connections Monthly Newsletters

General News

  • Durations for Carelon prior authorization approvals for MSK, cardiovascular or radiology services
    • Radiology: order numbers are valid from the date entered + 60 calendar days
    • Cardiovascular: order numbers are valid from the date entered + 60 calendar days
    • MSK:
      • Joint and Spine: order numbers are valid from the date entered + 60 calendar days
      • Interventional Pain: order numbers are valid for 10 business days from the date of service
      • Inpatient: order numbers are valid from the date of service + expected length of stay
    • Claim appeals submitted through Availity to result in online responses

Clinical News

  • Reminder the most recent updates to Medica’s UM policies, coverage and clinical guidelines will be effective 08/19/2024. Medica post notification of updates at least 60 days in advance on Medica.com.  You can view the updated guidelines online by following this link or you can request printed copies by calling 1-800-458-5512, option 1, then option 8, then ext 2-2355.

Pharmacy News

  • Effective 09/01/2024 Medica will expand step therapy for long-acting GCSF drug class and the full list can be viewed on the newsletter
  • Effective 09/01/2024 prior authorization will be required for Imdeltra

Network News

  • Effective 09/01/2024 Medica will make annual ancillary fee schedule updates for all products

Tips and Training

  • The training session for July is “Setup and billing for EW (Elderly Waiver) and HSS (Housing Stabilization Service Providers)”. The session date is 07/16/2024 and 11:30 am – 1:00 pm CT.

Arkansas Blue Cross Blue Shield – Providers’ News June 2024

June 10, 2024

Arkansas BCBS – Providers News June 2024

This month’s featured articles:

Arkansas Blue Cross and Blue Shield

  • 2024 Spring Provider Workshops
  • ABCBS to Match CMS fiscal year for DRG Inpatient Updates
  • Bevacizumab for Ophthalmologic Indications
  • Billing For Services to Provider Family Members Prohibited
  • Claims Incurred During the Credentialing Process
  • Corrected Claim Submission and Correcting Claim Rejections/Errors
  • Coverage Policy Manual Updates
  • Lucet and Carelon’s Post-Service Prepay
  • Medical Specialty Prior Authorization Medications
  • Meet New Network Development Representative (NDR) Dawn Roberts and JoalyVelasquez
  • Metallic Formulary Changes Effective July 1, 2024
  • Provider Data Management: New Provider Information Search
  • Standard Formulary Changes Effective July 1, 2024
  • Timely Filing Review

Federal Employee Program

  • Cervical Cancer Screenings
  • LBP KX Modifier: Coding for use of imaging for lower back pain diagnosis

Medicare Advantage

  • Centers for Medicare and Medicaid Services (CMS) Preclusion List
  • CMS Requirement for Provider Certification on National Plan and Provider Enumeration System (NPPES)
  • HIPAA and HITECH Reminders
  • Reminder on Billing Qualified Medicare Beneficiaries
  • Requirements for outpatient observation care

21 st Blue & You Fitness Challenge

Cigna Reimbursement Policy Update – Examinations billed with International Classification of Diseases, 10th Revision, Clinical Modification Z diagnosis codes

June 05, 2024

Cigna Reimbursement Policy Update – Exams billed with ICD10 Z diagnosis codes 081724

As a result of a recent review, we will administratively deny claims when International Classification of Diseases, 10th Revision, Clinical Modification Z diagnosis codes Z02.0-Z02.6, Z02.71, Z02.79, Z02.82- Z02.83, Z02.89-Z02.9, Z13.9, Z56.1, Z62.21, or Z63.6 are the only codes on the claim. Denials will include administrative appeal rights.

We will update the Diagnosis Coding Guidelines (R47) reimbursement
policy to reflect this change. This update is effective for dates of
service on or after August 17, 2024.

Anthem Provider Newsletter – June 2024

June 03, 2024

June 2024 Provider Newsletter – Provider News (anthem.com)

This month’s featured articles:

Administrative

Education and Training

Policy Updates

Products & Programs

Quality Management

 

Summit Provider Newsletter – June 2024

June 03, 2024

June 2024 Provider Newsletter – Provider News (summitcommunitycare.com)

This month’s featured articles:

Administrative

Education and Training

Policy Updates

Notice of Material Amendment to Healthcare Contract

Notice of Material Amendment to Healthcare Contract

Products & Programs

Notice of Material Amendment to Healthcare Contract

Quality Management