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.

Summit Community Care Newsletter – October 2024

October 01, 2024

Summit Community Care Provider Newsletter – October 2024

This month’s featured articles:

Digital Solutions

Notice of Material Amendment to Healthcare Contract

Policy Updates

Notice of Material Amendment to Healthcare Contract

Reimbursement Policies

Pharmacy

Notice of Material Amendment to Healthcare Contract

Notice of Material Amendment to Healthcare Contract

Quality Management

Anthem Provider Newsletter – October 2024

October 01, 2024

Anthem Provider Newsletter – Missouri October 2024

This month’s featured articles:

Administrative

Digital Solutions

Education and Training

Policy Updates

Medical Policy & Clinical Guidelines

Prior Authorization

Reimbursement Policies

Products & Programs

Pharmacy

Quality Management

Cigna – EviCore by Evernorth to manage precertification for molecular laboratory tests beginning November 1

September 25, 2024

Sign up for online orientation sessions.

Beginning November 1, EviCore by Evernorth® will manage precertification for Current Procedural Terminology (CPT®) codes for molecular laboratory tests for Cigna Healthcare customers.

What this means to you

Obtain precertification for molecular laboratory tests from EviCore by:

  • Website: EviCore.com/Provider
  • Telephone (866.668.9250)
  • Fax (855.774.1319)

Cigna Healthcare will continue to manage precertification requests until October 31. On November 1, EviCore will be available to take precertification requests by telephone, fax, and via their website.*

Online learning sessions

Beginning in October, EviCore will lead online session to help you and your staff understand the new precertification process. To register for and participate in a session:

  1. Go to evicore.webex.com.
  2. Select “Webex Training” from the menu bar on the left.
  3. Click the “Upcoming” tab. Choose “Cigna Molecular Laboratory Tests Provider Orientation.”
  4. Click “Register” next to the session you wish to attend.
  5. Enter the registration information.

After you have registered for the Webex session, you will receive an email containing the toll-free telephone number, meeting number, conference password, and a link to the web portion of the session. Please keep the registration email so you will have the link to the Webex and the call-in number for the session in which you will be participating.

If you are unable to participate in a session, you can obtain a copy of the presentation and other important documents at evicore.com/resources/healthplan/cigna. Documents are available in PDF format. You can download Adobe Reader from adobe.com/products/reader/.

Additional information

For more information about precertification for molecular laboratory tests, access the resources available at available at EviCore.com/Resources/HealthPlan/Cigna.

Cigna – EviCore to manage precertification for vascular intervention procedures beginning November 1

September 25, 2024

Sign up for online orientation sessions.

Beginning November 1, EviCore by Evernorth® will manage precertification for Current Procedural Terminology (CPT®) codes for vascular intervention procedures for Cigna Healthcare customers.

What this means to you

Obtain precertification for vascular intervention procedures from EviCore by:

  • Website: EviCore.com/Provider
  • Telephone (866.668.9250)
  • Fax (855.774.1319)

Cigna Healthcare will continue to manage precertification requests until October 31. On November 1, EviCore will be available to take precertification requests by telephone, fax, and via their website.*

Online learning sessions

Beginning in October, EviCore will lead online session to help you and your staff understand the new precertification process. To register for and participate in a session:

  1. Go to evicore.webex.com.
  2. Select “Webex Training” from the menu bar on the left.
  3. Click the “Upcoming” tab. Choose “Cigna Vascular Intervention Procedures Provider Orientation.”
  4. Click “Register” next to the session you wish to attend.
  5. Enter the registration information.

After you have registered for the Webex session, you will receive an email containing the toll-free telephone number, meeting number, conference password, and a link to the web portion of the session. Please keep the registration email so you will have the link to the Webex and the call-in number for the session in which you will be participating.

If you are unable to participate in a session, you can obtain a copy of the presentation and other important documents at evicore.com/resources/healthplan/cigna. Documents are available in PDF format. You can download Adobe Reader from adobe.com/products/reader/.

Additional information

For more information about precertification for vascular intervention, access the resources available at available at EviCore.com/Resources/HealthPlan/Cigna.

Cigna – EviCore by Evernorth to manage precertification for spine surgery beginning November 1

September 25, 2024

Sign up for online orientation sessions.

Beginning November 1, EviCore by Evernorth® will manage precertification for Current Procedural Terminology (CPT®) codes for spine surgeries for Cigna Healthcare customers.

What this means to you

Obtain precertification for spine surgeries from EviCore by:

  • Website: EviCore.com/Provider
  • Telephone (866.668.9250)
  • Fax (855.774.1319)

Cigna Healthcare will continue to manage precertification requests until October 31. On November 1, EviCore will be available to take precertification requests by telephone, fax, and via their website.*

 Online learning sessions

Beginning in October, EviCore will lead online session to help you and your staff understand the new precertification process. To register for and participate in a session:

  1. Go to evicore.webex.com.
  2. Select “Webex Training” from the menu bar on the left.
  3. Click the “Upcoming” tab. Choose “Cigna Musculoskeletal Spine Provider Orientation.”
  4. Click “Register” next to the session you wish to attend.
  5. Enter the registration information.

After you have registered for the Webex session, you will receive an email containing the toll-free telephone number, meeting number, conference password, and a link to the web portion of the session. Please keep the registration email so you will have the link to the Webex and the call-in number for the session in which you will be participating.

If you are unable to participate in a session, you can obtain a copy of the presentation and other important documents at evicore.com/resources/healthplan/cigna. Documents are available in PDF format. You can download Adobe Reader from adobe.com/products/reader/.

Additional information

For more information about precertification for spine surgery, access the resources available at available at EviCore.com/Resources/HealthPlan/Cigna.

Anthem BCBS – Notification of authorization fax number changes

September 05, 2024
 

Notification of authorization fax number changes

Anthem is in the process of shutting down specific authorization fax channels. This is to notify you the below fax numbers were decommissioned August 30, 2024.

Look for additional notifications as other authorization fax lines are retired.

Availity Authorizations is the preferred method for authorization intakes. If you cannot use Availity Authorizations, call our contact center at 833-545-9102, and we will work with you to determine the best submission method.

Available resources

Registering and accessing Availity is easy. If your organization is not registered for Availity, see Register and Get Started with Availity Essentials (Availity.com).

If you are not already familiar with Availity Authorization, training is available. Register for training today (Availity.com) and learn about the simple workflow for submitting digital authorizations.

These fax numbers were turned off August 30, 2024

800-722-7427 866-447-1341 877-332-8239 877-539-3856 888-620-0306
804-678-7943 866-487-3757 877-381-8696 877-539-3860 888-656-5721
866-444-8162 866-487-7453 877-381-8698 877-539-9588 866-447-1273
866-445-6507 866-553-8823 877-476-9175 877-539-9589 866-993-5966
866-445-7207 866-787-8503 877-476-9176 877-549-3987 877-539-3855
866-446-0030 866-959-1394 877-539-3851 877-825-8419 888-438-7081

Anthem Provider Newsletter – September 2024

September 03, 2024

Anthem Provider Newsletter – Missouri September 2024

This month’s featured articles:

Administrative

Digital Solutions

Education and Training

Medical Policy & Clinical Guidelines

Prior Authorization

Federal Employee Program (FEP)

Long-Term Services and Supports

Pharmacy

Quality Management

Summit Community Care Newsletter – September 2024

September 03, 2024

Summit Community Care Provider Newsletter – August 2024

This month’s featured articles:

Administrative

Notice of Material Amendment to Healthcare Contract

Digital Solutions

Policy Updates

Notice of Material Amendment to Healthcare Contract

Medical Policy & Clinical Guidelines

Notice of Material Amendment to Healthcare Contract

Prior Authorizatio1

Notice of Material Amendment to Healthcare Contract

 

Cigna Medicare Advantage – Reimbursement Policy Update – Facility claims for Emergency Room Evaluation and Management Services

August 21, 2024

Cigna – Medicare Advantage Policy Uupdate Facility Claims for ER EM Services 082524

As a result of a recent review, we will review facility claims submitted with emergency room (ER) evaluation and management Current Procedural Terminology (CPT®) code 99285 for billing and coding accuracy. Claims may be adjusted and reimbursed at a more
appropriate CPT code level.

Administrative appeal rights are available. We will update the Emergency Room Services (MAR36) reimbursement policy to reflect this change.

This update is effective for dates of service on or after August 25, 2024, and applies if the customer was discharged from the ER.

Summit Community Care – Understanding psychological and neuropsychological testing services

August 20, 2024

Summit Community Care appreciates the compassion with which you care for your patients, our members. We know the delivery of high-quality mental healthcare services for Summit Community Care members requires successful collaboration. Because timely decisions and successful approvals of medically necessary services are an important part of collaboration, we encourage you to review the following information.

Summit Community Care – Understanding psychological and neuropsychological testing services