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: you can however, view your contract listing and rate information via the online rate matrix. A designated staff member at your organization should have login information to access this file. If you are contracted through a PHO, please contact your PHO representative if you have questions regarding your Mercy Managed Care Contracts.

Provider Changes

As a contracted provider, it is important to notifiy us immediately of changes 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.

Cigna – Drug Formulary Changes Effective 1/1/2019

October 01, 2018

Please review the attached notice from Cigna regarding changes to their drug formulary effective January 1, 2019.

Please note that Cigna will be sending a letter to all providers who have been identified as having patients who have been prescribed a drug that is affected by the changes.  Also, letters will be sent explaining the drug list changes to the affected patients.

Cigna – Drug Formulary Changes 010119 REVISED

Cigna SureFit Kansas City

September 24, 2018

Beginning October, 1, 2018, Cigna will offer a new plan called Cigna SureFit to employers and their employees in the Kansas City area.  This new plan requires enrolled customers to use only providers who participate in the network aligned to the Cigna SureFit plan, including primary care providers and specialists.  Out-of-network coverage is not available for customers with Cigna SureFit plans, unless it is for a medical emergency.

Since the network for this plan is based in Kansas City, Mercy providers in Southwest Missouri, Arkansas and Kansas will be considered out-of-network for all patients enrolled in this plan.

Please take time to review and share the attached flyer.  The flyer includes sample identification cards to assist with identifying patients enrolled in this plan as well as plan information and a map of the network service area.

Cigna SureFit Kansas City

September 17, 2018

Please see the attached Fax Blast regarding Ambetter Medical Necessity  Provider Bulletin.

 

Non-claim related Complaints/Grievances and Medical Necessity Appeals should be sent to:

Ambetter from Home State Health Complaint and Grievances Coordinator (CGC)

16090 Swingley Ridge Road, Suite 500 Chesterfield, MO 63017

 

Provider Grievances and Appeals should be sent to:

Ambetter from Home State Health Claim Disputes

PO Box 5000 Farmington, MO 63640-5000

AMB-MedNecProviderBulletin_Web posting 090518

Home State Plans-Payment Policy Updates Effective 11/01/2018

August 29, 2018

Please review the attached memo related to payment policy updates from Home State.  These apply to the Home State Managed Medicaid plan, Allwell and Ambetter.

Payment Policy Updates Effective 11.01.2018

Aetna – Additional Code Required for 340B Acquired Drugs

August 17, 2018

Please review the attached notice from Aetna regard additional coding required for 340B acquired drugs.

Aetna 340B coding effective 08012018

Cigna – Infusion and Injection Administration Effective 11/11/18

August 16, 2018

Please review the attached policy update from Cigna regarding changes regarding infusion and injection administration services received in the emergency room.

Cigna – Infusion and Injection Administration 111118