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.

Anthem BCBS – Voluntary recall of Philips Respironics CPAP machine, BiPAP machine, and ventilators

June 28, 2021

Anthem BCBS has issued the following provider update regarding a voluntary recall of Phillips Respironics CPAP machines, BiPAP machines and ventilators.

Anthem BCBS Phillips Respironics Recall 061421

Anthem Provider Newsletter – Missouri June, 2021

June 01, 2021

This month’s featured articles…

Products & Programs:

  • Let’s vaccinate


  • Update on requirement to obtain certain specialty drugs from CVS Specialty Pharmacy
  • Updates for specialty pharmacy are available – June 2021
  • Pharmacy information available at anthem.com


  • Keep your contact information current
  • Answering your claims questions is easier through chat; secure messaging will sunset soon, start using chat now

Digital Tools:

  • Regular check-ins with your clearinghouse could affect timely filing
  • Physicians and clinical care teams: Imaging for lower back pain does not improve outcomes, study finds
  • Interactive Care Reviewer’s new copy feature decreases time to submit authorization request
  • Submit EDI corrected claims via Availity or EDI
  • Digital solution options with Availity
  • Two great learning resources on one secure portal

Medical Policy & Clinical Guidelines:

  • Medical policy and clinical guideline updates – June 2021
  • Prior authorization for genetic testing medical policy effective September 1, 2021
  • Updates to AIM advanced imaging clinical appropriateness guidelines
  • Updates to AIM musculoskeletal program clinical appropriateness guidelines

Reimbursement Policies:

  • Reimbursement policy update: Outpatient facility claim edits

Federal Employee Plan (FEP):

  • DEXA bone scan criteria for the Federal Employee Program®


  • Medicare News – June 2021
  • Medical policies and clinical utilization management guidelines update
  • Reminders for Medicare Advantage Group Retiree PPO plans and National Access Plus FAQ
  • Reimbursement policy reminder: Inpatient readmissions
  • MCG Care Guidelines 25th Edition

Anthem Provider Newsletter – Missouri June 2021

Medica May 2021 Newletter

May 10, 2021

If your group opted-in to Medica through Mercy you are only contracted with the Balance by Medica plan which is a direct-contracted Individual and Family plan (IFB).

May2021Conn – Final 4-19-21

Cigna – Drug Formulary and Specialty Drug Changes – July 1, 2021

May 10, 2021

Effective July 1, 2021, Cigna will make changes to their commercial drug formularies as well as the specialty medical drugs they cover to help ensure their customers have access to affordable and quality health care.

Please review the attached notice.

Cigna – Drug Formulary Changes 070121


Anthem Provider Newsletter – Missouri May, 2021

May 03, 2021

This  month’s featured articles…



  • Specialty pharmacy prior authorization update – Certain drugs for treatment of  ocular conditions continue to require prior authorization
  • Updates for specialty pharmacy are available – May 2021


  • Resources to support diverse patients and communities
  • Referring to network DME providers for negative pressure wound therapy helps members save on out-of-pocket costs
  • 2021 Affirmative statement regarding utilization management decisions
  • A helpful and complete guide to covered well-child visits
  • May is National High Blood Pressure Education Month
  • Digital online scheduling feature now available in the Availity Portal
  • Provider bulletins for medical and itemized bill attachments:  Electronic solutions at your fingertips
  • Sending larger digital attachments through Availity

Medical Policy & Clinical Guidelines:

  • New prior authorization requirement: Kidney transplantation
  • Update to AIM Specialty Health oncologic imaging clinical appropriateness guidelines
  • Updated AIM rehabilitative program effective August 1, 2021 – Initial evaluations and site of service reviews
  • Modification to voluntary Cancer Care Quality Program (CCQP) enhanced reimbursement to begin July 1, 2021

Reimbursement Policies:

  • Reimbursement policy update: Claims Requiring Additional Documentation – Facility
  • Reimbursement policy reminder: Readmission – Facility
  • Reimbursement policy update: Frequency editing – Professional


  • Keep up with Medicare news – May 2021
  • Maximizing efficient, high quality COVID-19 screenings

Anthem Provider Newsletter – Missouri May 2021


Cigna Network News 2nd Quarter 2021

April 29, 2021

This quarter’s featured articles…



  • Engaging with patients virtually


  • Preventive care services policy updates
  • Precertification updates
  • Clinical, reimbursement, and administrative policy updates


  • Online benefit viewing through procedure code lookup
  • Online appeals and claim reconsideration requests
  • Webinar schedule for digital solutions


  • Cigna + Oscar plans expand in California and Georgia
  • LocalPlus plans expand in Midwest
  • Cigna Gene Therapy Program updates


  • Claim submission PO boxes and payer IDs closed
  • Qual-Lynx workers’ compensation COVID-19 updates
  • Update contact information via email
  • Changes in drug formulary effective January 1, 2021
  • National Preferred Formulary added as an option
  • Study: Greater Rx adherence in home delivery customers
  • Helping providers give new hope to patients with cancer
  • Accredo provider website improves prescribing capabilities


  • Reminder: 2021 Cigna Medicare plan highlights


  • Claim denial prevention tips
  • Appeal reminders
  • intelliPath technology to help ease eviCore precertification process
  • Timely communication of test results
  • Providers must meet language assistance
  • compliance requirements
  • Home health services have transitioned to eviCore
  • Oncology advanced illness care
  • Cigna ambulatory medical record reviews
  • ASH management of acupuncture program: National expansion
  • Participate in the 2021 Leapfrog Hospital Survey
  • Updated LifeSOURCE provider reference guide now available


  • Market Medical Executives contact information
  • Quick guides for Cigna and Medicare Advantage plans
  • Cigna Reference Guides
  • Use the network
  • Patient reviews reminders
  • Quick Guide to Cigna ID cards
  • Urgent care for nonemergencies
  • View drug benefit details using real-time benefit check
  • Transformations behavioral health digital newsletter
  • CareAllies education series
  • Resources to enhance interactions with culturally diverse patients
  • Have you moved recently? Did your phone number change?
  • Get digital access to important information
  • Access the archives
  • Letters to the editor

Cigna 2nd Quarter Network News April 2021

Home State Health – Updated Coding, Payment and Clinical Policies 060121

April 05, 2021

Home State Health has released the attached announcement regarding the following changes to their coding, payment and clinical policies effective June 1, 2021.


  • Drug Payment Reduction – Medicare
  • Outpatient Testing for Drugs of Abuse:  Presumptive Frequency Edits – Medicaid, Medicare and Marketplace
  • Correct Coding Update (Cotiviti 8, WCIVC B2) – Medicaid, Medicare and Marketplace

Home State – Updated Policies 060121

Cigna Coverage Policy Update – Continuous Glucose Monitors

April 05, 2021

Effective July 1, 2021, Cigna will change how they cover therapeutic continuous glucose monitors (CGMs) for patients who have both Cigna medical and pharmacy coverage.  For these patients, they will cover all components of therapeutic CGMs under the pharmacy benefit and may no longer cover therapeutic CGMs filled through a durable medical equipment or medical supply vendor under the medical benefit.


Additional information is included on the attached announcement.

Cigna – Coverage Policy Update – Continuous Glucose Monitor 070121

Cigna Coverage Policy Updates – Specialty Medical Drugs

April 05, 2021

Effective July 1, 2021, Cigna will make changes to the specialty medical drugs they cover to help ensure their customers have access to affordable and quality health care.  As a result, ELIGARD®, Fensolvi®, LUPRON DEPOT®, LUPRON DEPOT-PED®, and TRELSTAR® will require medical precertification and may be subject to site-of-care management.  They will also require medical precertification for FIRMAGON® and Zoladex®.


Additional information is included on the attached announcement.

Cigna – Coverage Policy Update – Specialty Drug Coverage 070121