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 Medicaid-Synagis Guidelines

October 01, 2019

Please see the notice from Home State Health regarding the proper usage of Synagis. 

 

Product:  Home State Health (Medicaid)

 

Attached, please find our Provider Notice regarding Synagis injections.  Home State Health is actively encouraging appropriate use of Synagis® injections for prophylaxis against RSV, and would like to assist in ensuring that your patients receive this treatment if it is indicated. We have included the current guidance from Missouri HealthNet regarding inclusion criteria for this treatment as well as other resources to help patients receive this treatment when appropriate.

Final – Synagis Provider Letter from Home State Health_Sept 2019

Cigna – Precertification and Claim Submission Requirements for Molecular Genetic Laboratory Testing

September 06, 2019

Please review the attached information from Cigna regarding changes in precertification and claim submission requirements for molecular genetic laboratory testing.  This change goes into effect on December 1, 2019.

Cigna – Molecular Genetic Testing Requirements 120119

Cigna – Request for NDC information on drug-related medical claims

September 06, 2019

Please review the attached announcement from Cigna regarding including NDC codes on claims.

Cigna – NDC Information on Medical Claims

Home State Health Provider Notice: Surgical Quality and Safety Management Program – UPDATED 10/28/19

September 06, 2019

Please review the attached information regarding an announcement from Home State Health.

Products:

Home State Health (Medicaid)

Ambetter from Home State Health (Marketplace)

Allwell from Home State Health (Medicare HMO, D-SNP)

Good afternoon,

Attached, please find our provider notice regarding the Surgical Quality and Safety Management Program, which will launch on December 9, 2019.  The program is designed to work collaboratively with physicians to promote patient safety through the practice of high quality and cost-effective care for Home State Health members undergoing Musculoskeletal Surgical Procedures.

We will provide additional information and training opportunities, as we get closer to the effective date of the program. Should you have any questions at this time, please contact the Home State Health Provider Services team at the phone numbers listed on the notice.  Please share this information within your health system/practice/group as you deem necessary.

UPDATE – Provider Webinars are being offered later this month and early November, providing an overview of Turning Point Healthcare Solutions’ Surgical Quality and Safety Management Program.  Please review the attached webinar announcement for more specific information, including dates and registration links.  This program becomes effective on 12/9/19.

Turning Point Provider Notice 090519

TurningPointHshWebinrBlurb

Home State Health Overdose Awareness Information

August 30, 2019

Please review the attachment from Home State Health regarding International Overdose Awareness Day held on August 31, 2019.  The attachment includes links you can follow to help with this issue.

Home State Health International Overdose Awareness Day

Allwell from Home State Health – Referral Requirement

August 06, 2019

Please review the attached information regarding a change in referral requirements for Allwell from Home State Health.

Allwell Referral Requirement Removed 080619