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.

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

 

Cigna Medicare Advantage Reimbursement Policy Update – Bilateral procedure codes billed without the required modifier

May 31, 2024

Cigna – MA reimbursement policy update – Bilateral Procedure Codes Billed Without the Requested Modifier 081724

As a result of a recent review, we will implement a new reimbursement policy, Modifier SO Bilateral Procedures (MAMS0), to administratively deny bilateral procedure codes when billed without the required modifier, LT (left side), RT (right side) or SO, as appropriate.

Denials will affect the claim line only and include administrative appeal rights. However, a corrected claim should first be submitted for payment. This update is effective for dates of service on or after August 17, 2024.

Cigna Medical Coverage Policy Update – Folate testing billed with CPT codes 82746·and 82747

May 31, 2024

Cigna – Medical coverage policy update – Folate Testing Billing with CPT 82746 and 82747 081724

As a result of a recent review, we will implement a new medical coverage policy, Serum Folate and Red Blood Cell Folate (0567), for folate testing billed with Current Procedural Terminology (CPT®) codes 82746 and 82747. We will administratively deny CPT code 82746 when billed with a diagnosis code that is not reimbursable. In addition, we will
administratively deny CPT code 82747 regardless of the diagnosis, as it is not reimbursable.

Denials will affect the claim line only and include administrative appeal rights. However, a corrected claim should first be submitted for payment for claims billed with CPT code 82746. This update is effective for dates of service on or after August 17, 2024.

Cigna Healthcare to make digital claim and precertification correspondence available on the Cigna for Health Care Professionals website

May 16, 2024

Please click the following attachment to see Cigna’s announcement regarding their roll out of digital claim and precertification correspondence to be made available on Cigna for HCP website.

Cigna Healthcare to make digital claim and precertification correspondence available

Cigna Reimbursement Policy Update – Modifier 50 billed with unilateral procedure codes

May 06, 2024

Cigna Reimbursement Policy Update – Modifier 50 071424

As a result of a recent review, we will administratively deny unilateral
procedure codes when billed with modifier 50. Denials will affect the
claim line only and include administrative appeal rights.

We will update the Bilateral Procedures (MS0) reimbursement policy to reflect this change. This update is effective for dates of service on or after July 14, 2024.

United Healthcare May Network News

May 01, 2024

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

United Healthcare May 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.

May monthly overview | UHCprovider.com

There are also links provided for these items:

  • A reminder regarding the UHC Provider Portal
  • Review of Surest Medical injectable policy updates
  • 2023 Quality Improvement survey results
  • A link to medicaid.gov