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.

Sunflower Health Plan encourages you to visit our website at SunflowerHealthPlan.com to find information and resources.

Programs:

• Information about Sunflower Health Plan
• Pharmaceutical Management Procedures, Pharmaceutical Restrictions/Preferences (annual/updates), and Other Pharmacy information
• Sunflower’s Quality Program
• HEDIS Program and Data Collection Process
• Staff Availability
• Appeal & Grievance Information

Documents:

• Current Provider Manual
• Preferred Drug List (PDL)
• Provider & Member Rights and Responsibilities
• Adopted Preventive and Clinical Practice Guidelines
• Availability of Criteria / Utilization Management Criteria
• Affirmative Statement about Incentives

Secure Portal Resources:

• Check or Submit Prior Authorization Requests
• Check Prior Authorization Requirements
• View, Adjust or Submit Claims
• Complete Assessments and View Cost Sharing, Care Plans and Coordination of Benefits
• View Your Patient Roster
• Check Patient Care Gaps
• Access to Case Management and Behavioral Health Referrals

Additional provider resources are also available – including forms, helpful links, FAQs, quarterly provider newsletters, fax blasts, E-blasts and other provider updates and much more. If you would like us to provide a printed copy of the Provider Manual, Provider Newsletters or any other document found on our website, please call Customer Service at 1-877-644-4623.

NU Modifier

KMAP uses the Medicare DME, Prosthetics/Orthotics & Supplies Fee Schedule to determine which procedures are appropriately billed with modifier NU. Procedure codes listed on the file with modifier NU can be billed with this modifier (such as A4233 NU). Any procedure code not listed on this file with modifier NU will be denied.

Please refer to the CMS DMEPOS fee schedule for most up to date information to determine appropriate modifier NU usage. All other procedures codes billed with the NU modifier will deny, EXMo, Deny: Resubmit with Correct Modifier.

• CARC 4 “The procedure code is inconsistent with the modifier used or a required modifier is missing.”
• RARC N517 “Resubmit a new claim with the requested information.”

If you have questions about this bulletin or other provider resources, please contact Customer Service at 1-877-644-4623.

The Fall issue of the Sunflower Provider Report is now available on SunflowerHealthPlan.com!

Check out the Provider Report to read about:

• Women’s health tips
• HEDIS information
• 2017 Sunflower Summit Award Winner
• And more!

Please let us know if there is something specific you would like to see in the Provider Report. Thank you for all you do for the health of our members!

Anthem Network Update November 2017

Cigna Network News October 2017

Follow this link to additional information regarding the new claims administrator for patients enrolled in a plan through HealthChoice. 

Please remember that we are only contracted with HealthChoice in the following areas:  Missouri – Joplin and Carthage  Kansas – Fort Scott and Columbus.

HealthChoice TPA Updates 102717

Follow the link below to the Fall edition of HealthChoice Network News.  Please remember that Mercy providers are only contracted with HealthChoice in the following areas:  Missouri – Joplin and Carthage  Kansas – Fort Scott and Columbus.

HealthChoice Network News Fall 2017

Here are this week’s bulletin topic from the Kansas Medical Assistance Program (KMAP). Visit our provider news page to see Sunflower bulletins and other news.

KMAP BULLETIN: PAS AND APRNS IN MULTISPECIALTY CLINICS
Effective with dates of service on and after November 1, 2017, physician assistants (PAs) and advanced practice registered nurses (APRNs) in multispecialty clinics may append modifier U8 when seeking reimbursement for new patient E&M visits (procedure codes 99201-99205). Read more …

October 25: Provider Training Workshop in Wichita. We still have availability for this valuable training opportunity!

This webinar will provider information to attendees on cultural competency, disability literacy and person-centered planning.

• When: Thursday, November 16, 2017
• Time: 12:00-1:00pm
• Where: Skype Online Webinar
• Web Link: Join Skype Meeting
• Conference Line: (314) 512-9400 (US) or (855) 229-5962 (Skype) Ext 29400
• Conference Code: 939-509-9122

You do not need to have access to Skype to join this meeting. Please click on the hyperlink above and/or use the call in number provided.

If you have questions about this bulletin or other provider resources, please contact Customer Service at 1-877-644-4623.

Please review the attached regarding Payment Policy Updates to Home State Missouri Managed Medicaid that will take effect on 12/01/2017.

Payment Policy Updates Effective 120117