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.

Home State Health- Casting Referral Faxblast

July 24, 2018

The attachment contains important information related to referral requests and fracture care, especially where casting is performed.

Casting Referrals 072018

Home State Medicaid Notification of Pregnancy

July 17, 2018

Please view the attachment from Home State Medicaid and forward as necessary.

NOP Completeness

Ambetter from Home State Health – Claims Filing Information for Behavioral Health Claims

July 16, 2018

Please review the attached notice from Ambetter from Home State Health regarding claim filing for behavioral health claims.

Ambetter BH Claims Filing Notice 071118

 

Cigna – Cardiac Resynchronization Therapy Policy Update Effective 10/1/2018

July 02, 2018

Please review the attached update from Cigna regarding changes to their policy on Cardiac Resynchronization Therapy effective October 1, 2018.

 

Cigna – Cardiac Resynchronization Therapy 100118

Cigna – Lumbar Laminectomies Policy Update Effective 9/16/2018

June 19, 2018

Please review the attached update from Cigna regarding changes to their policy on lumbar laminectomies effective September 16, 2018.

Cigna – Lumbar Laminectomies 091618 (2)

Cigna – Opioid Coverage Changes Effective 7/1/2018

June 19, 2018

Please review the attached update from Cigna regarding changes to their policy on opioid usage effective July 1, 2018.

Autism Spectrum Disorder Fax Blast 06.18

Home State Medicaid Summer 2018 Newsletter

June 12, 2018

Attached you will find the 2018 Summer Newsletter from Home State Medicaid.  Please forward to the correct area.

Home State Medicaid Summer 2018 Report

Articles include:

  • Well visits help keep children healthy
  • Teens need special care
  • Learn more about HEDIS

o   Vaccines are key to community health

o   HEDIS for immunizations

  • Meeting Appointment Accessibility Standards
  • Ensuring appropriate, quality care
  • Help for new moms
  • Be on the lookout for depression

 

Our past quarterly newsletter publications are housed here:

https://www.homestatehealth.com/providers/tools-resources.html

 

Cigna – Discover a new precertification resource

June 01, 2018

Cigna has developed a new web page devoted to precertification assistance.  Please visit the following link to find information on the following:

  • Information on how to access a complete list of services that require precertification.
  • Information on how to request precertification for medications and medical procedures, including from contracted ancillary providers, for services such as high-technology radiology, integrated oncology management, and musculoskeletal and pain management.
  • Answers to some of the most frequently asked questions related to precertification.

CignaforHCP.com/Precertification

 

Anthem Blue Cross Blue Shield Training Opportunities

May 21, 2018

Please review the attached information regarding upcoming training opportunities for the Availity Portal and Anthem’s Interactive Care Reviewer.

 

Availity ICR Webinar Invitation