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.

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

Anthem BCBS Updated Provider Manual

August 01, 2018

Anthem Blue Cross and Blue Shield (Anthem) reviews and updates their online Provider Manuals annually.  The updated manual for Missouri is now available on our public provider website at www.anthem.com.  Select Providers, under Partner Login. On the Provider landing page, choose Find Resources for Your State and then select Missouri from the list.  On the Provider home page, choose Communications, Publications to view the manual.

Anthem Provider Manual – September 2018


Cigna – Genetic Testing Precertification Update Effective 10/22/2018

July 31, 2018

Please review the attached update from Cigna regarding changes to their precertification policy on Genetic Testing effective October 22, 2018.

Cigna – Genetic Testing Update 102218