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 Provider Newsletter – Missouri April, 2021

April 05, 2021

This  month’s featured articles…

Behavioral Health:

  • The health of millennials: Trends in behavioral health conditions

Pharmacy:

  • Correction: Updated formulary lists for commercial health plan pharmacy benefit effective April 1, 2021
  • Updates for specialty pharmacy are available – April 2021
  • Pharmacy information available at anthem.com

Administrative:

  • Important update to provider UM reimbursement penalties and corresponding entry in Provider Manual
  • The 2021 Provider Manual is now available
  • Does your practice offer telehealth services? Let us know!
  • Information Center – Access important policies, forms and helpful resources
  • Understanding Availity roles for electronic data interchange (EDI)
  • Make the change to digital authorization/referral and hospital admission notifications using EDI
  • Attention facilities: Sending admission, discharge and transfer data results in improved care management for patients
  • Chat directly with a prior authorization specialist
  • Keeping up with routine vaccination during COVID-19
  • Interactive bilingual website taking action for our health
  • Join Anthem in talking about racism and its impact on health

Medical Policy & Clinical Guidelines:

  • Medical policy and clinical guideline updates – April 2021
  • Update: Clinical guideline adoption postponed
  • MCG Care Guidelines 25th Edition available
  • Updated guidance on prior authorization requirements for admissions to in-network skilled nursing facilities (SNFs)
  • Maximizing efficient, high quality COVID-19 screenings
  • Update for Commercial providers: AIM sleep program CPT code E1399, NOC: Durable medical equipment, miscellaneous

Reimbursement Policies:

  • New reimbursement policy: Newborn Inpatient Stays for facilities

Federal Employee Plan (FEP):

  • HEDIS 2021 Federal Employee Program® medical record request requirements

Medicare:

  • Does your practice offer telehealth services? Let us know!
  • Oncology dose reduction program beginning July 1, 2021
  • Clinical criteria updates notification – November 2020
  • Clinical criteria updates notification – December 2020

Anthem Provider Newsletter – Missouri April 2021

Anthem Provider Newsletter – Missouri March, 2021

March 01, 2021

This  month’s featured articles…

 

Pharmacy:

  • Site of Care medical necessity reviews for long-acting colonystimulating factors begin June 1, 2021
  • Updates for specialty pharmacy are available – March 2021
  • Some HIV medication combinations may require prior authorization

Administrative:

  • Verifying and updating your provider information
  • Medical attachment capability now includes itemized bills and more!

Medical Policy & Clinical Guidelines:

  • Update: Notice of changes to the AIM Small Joint Surgery guideline

Reimbursement Policies:

  • Claims editing update for ICD-10-CM Excludes 1 notes

Medicare:

  • Medicare News – March 2021
  • New provider directory indicator for telehealth services
  • Medical policies and clinical utilization management guidelines update

Anthem Provider Newsletter – Missouri March 2021

Aetna Office Link Updates – March 2021

February 26, 2021

This month’s featured articles:

  • Changes to our National Precertification List (NPL)
  • Third Party Claim and Code Review Program
  • Services related to a denied primary surgical procedure
  • Billing for allergy testing
  • Changes to commercial drug lists begin on July 1, 2021
  • Important pharmacy updates

Aetna Office Link Updates – March 2021

Cigna – eviCore and CareCentrix Transition Notification Effective February 2, 2021

February 03, 2021

On January 31, 2021, Cigna will end its relationship with CareCentrix.  Beginning on February 1, 2021, eviCore healthcare (eviCore) will manage home health, durable medical equipment (DME), and home infusion therapy.  Specialty home infusion therapy services will be available through Accredo, a Cigna specialty pharmacy, as well as other Cigna-participating specialty pharmacies.

Attached you will find a letter from Cigna outlining changes to home health, durable medical equipment, and home infusion therapy services for their commercial customers along with a quick reference guide  regarding patient discharge information for in-home services.

Cigna eviCore Transition Discharge_Planner_HH-DME-HIT_Letter

Cigna eviCore Discharge_Planner_HH-DME-HIT_flyer 2021

Aetna Prior Authorization Requirements – Effective May 1, 2021

February 03, 2021

Aetna’s Enhanced Clinical Review program with eviCore healthcare requires authorization for certain high tech procedures.  Effective May 1, 2021, all providers will be required to obtain authorization for the services listed in the attached notice.  This affects members in our Commercial and Medicare Advantage HMO/PPO Aetna® products.

Aetna Prior Authorization Requirements 050121

Anthem Provider Newsletter – Missouri February , 2021

February 01, 2021

This month’s featured articles…

Pharmacy:

  • Anthem to update formulary lists for commercial health plan pharmacy benefit
  • Prior authorization updates for specialty pharmacy are available – February 2021
  • Pharmacy information available at anthem.com

Administrative:

  • New provider directory indicator for telehealth services
  • New Anthem utilization management tool now available on Availity: Authorization Rules Lookup tool
  • Procedure searches in Find Care – new sort option

Medical Policy & Clinical Guidelines:

  • Medical Policy and Clinical Guideline Updates – February 2021

Reimbursement Policies:

  • Reimbursement policy update: Emergency Room Transfers – Facility
  • Reimbursement policy update: Treatment Rooms with Office
  • Evaluation and Management Services – Facility

Reimbursement Policies:

  • PN for UM AROW Item 1330
  • Medical drug benefit clinical criteria updates – February 2021
  • College of the Ozarks offers Medicare Advantage option

Anthem Provider Newsletter – Missouri February 2021

Cigna Network News – 1st Quarter 2021

January 26, 2021

This quarter’s featured articles:

 

FEATURE ARTICLE

  • Resources to support physical and emotional well-being

POLICY UPDATES

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

ELECTRONIC TOOLS

  • CignaforHCP.com two-step security feature to begin
  • CignaforHCP.com enhances benefit lookup experience
  • Cigna ends participation with CAQH for EFT enrollments on EnrollHub
  • Submit pended claim documentation online
  • Webinar schedule for digital solutions

CONNECTED CARE

  • Staying connected with your patients through virtual care
  • Behavioral Health Centers of Excellence program

NETWORK UPDATES

  • LocalPlus plans expand in 2021
  • Cigna Connect Individual & Family Plans: 2021 update
  • Cigna Plus: A new Individual & Family Plan in Chicago
  • Cigna Gene Therapy Program
  • Cigna + Oscar plans in Georgia and Tennessee

QUALCARE NEWS

  • Reminder: HMO and PPO networks remain in focus
  • Claim submission post office boxes closed

PHARMACY NEWS

  • Transition to Express Scripts Pharmacy complete
  • Accredo: Making prior authorizations easier
  • Site of care for oncology products

MEDICARE NEWS

  • Reminder: 2021 Cigna Medicare plan highlights

GENERAL NEWS

  • Home health services transition to eviCore
  • Cigna Sleep Management Program transitions to eviCore
  • HEDIS data collection is right around the corner
  • Claim appeal submission tips
  • Hospital price transparency rule
  • Low health literacy can affect your patients’ outcomes
  • Tips to enhance communications with diverse patients
  • Resources to reduce South Asian health disparities

HELPFUL REMINDERS

  • Market Medical Executives contact information
  • Updated Cigna reference guides now available
  • Use the network
  • Transformations behavioral health digital newsletter
  • Patient reviews reminders
  • Quick Guide to Cigna ID cards
  • Urgent care for nonemergencies
  • View drug benefit details using real-time benefit check
  • 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 Network News 1st Quarter 2021