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.

Please see attached notice regarding the following new payment and clinical policies that Home State Health will roll out effective 10/01/2020.

• Multiple Diagnostic Cardiovascular Procedure Payment
• Leveling of Care:  Evaluation & Management Overcoding
• Outpatient Testing for Drugs of Abuse.

Additional information can be found on their web site:  https://www.homestatehealth.com/providers/tools-resources/clinical-payment-policies.html

HshMOprvdrPolicyUpdate2020

This month’s featured articles…

• Update: New go-live date for level of care medical necessity review of upper and lower endoscopy procedures
• 2019 Commercial member satisfaction with behavioral health care and services survey results
• Updated coverage for HIV PrEP medications
• Anthem prior authorization updates for specialty pharmacy are available – July 2020
• Important change to prior authorization requests for inpatient hospital admissions
• Welcome to the Custom Learning Center in Availity
• Anthem Commercial Risk Adjustment (CRA) Reporting Update:  2020 Program Year Progression – What’s in it for you and your patients?
• New MCG 24th Edition Guidelines
• Update: Notice of changes to the AIM Musculoskeletal Program prior authorization requirements and setting determination
• Admission review process for Anthem Blue Cross and Blue Shield Federal Employee Program® (FEP) members
• Medicare News – July 2020
• Prior authorization codes moving from AIM Specialty Health to Anthem Blue Cross and Blue Shield

Anthem Provider Newsletter – Missouri July 2020

Attached, please find a provider notice from Allwell from Home State Health regarding Medicare DRG INCREASES FOR COVID-19 TREATMENT SERVICES UNDER Coronavirus Aid, Relief, and Economic Security (CARES) Act.

COVID-19 Medicare CARES Act DRG Increases 6.15.2020

Please review and share the attached notices from Cigna regarding changes to their coverage policies.

• Coding for Prostate Needle Biopsy – Effective 8/18/2020
• Expansion of Specialty Medical Injectables – Effective 9/1/2020
• Nucleic Acid Pathogen Panel – Effective 8/16/2020
• Site of Care for Pegfilgrastim Products – Effective 9/1/2020

Cigna – Reimbursement Policy Update – Prostate Needle Biopsy 081820

Cigna – Coverage Polidy Update – Specialty Medical Injectables

Cigna – Medical Coverage Policy Update – Nucleic Acid Pathogen Panel

Cigna – Site of Care for Pegfligrastim Products 090120

Cigna Network News 2nd Quarter 2020

Anthem Provider Newsletter – Missouri May 2020

Please review and share the attached notice from Cigna regarding the following reimbursement and medical coverage policy updates going into effect during the second quarter of 2020.

• Care Integration Services
• Transthoracic Echocardiography in Adults

Cigna – Coventry Policy Updates – 2nd Quarter 2020

Please review the attached policy update from Cigna effective May 18, 2020.

Cigna – Nucleic Acid STD Panel Edits 051820

Please review the attached announcement from Anthem BCBS.

In addition to the proactive steps Anthem has already taken to support care providers and protect members, associates and communities against COVID-19, Anthem announced, effective April 1, that they will expand coverage for their members undergoing treatment related to COVID-19 diagnosis.

The expansion covers the wavier of cost shares for COVID-19 treatment received through May 31, 2020.  Anthem will reimburse health care providers at in-network rates or Medicare rates, as applicable, for Anthem’s affiliated health plan fully insured, Individual, Medicaid and Medicare Advantage members.  Anthem encourages self-funded employer participation; however, self-insured employers will be able to opt out of participation.

Anthem Waives Cost Share for COVID19 Treatment 040120

Please review the attached provider newsletter from Anthem Blue Cross Blue Shield.

Anthem Provider Newsletter – Missouri April 2020