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 August 2022

August 01, 2022

This month’s featured articles:

Administrative:

  • AIM Specialty Health phone number update
  • Update: outpatient prepay itemized bill review program
  • New patient evaluation and management services when reported for the same patient within the last three years
  • Timely updates help keep our provider directories current

Digital Tools:

  • Add supporting documents directly to your claims with the new Claims Status Send Attachments feature
  • Introducing the Provider Learning Hub

Behavioral Health:

  • Telehealth visits can impact after-hospitalization follow-up care for mental illness

Pharmacy:

  • Specialty pharmacy updates – August 2022
  • Pharmacy information available at anthem.com

Medicare:

  • Keep up with Medicare News – August 2022

Anthem Provider Newsletter – Missouri August 2022

Medica – August 2022 Connections Newsletter

July 29, 2022

General New

Clinical News

Pharmacy News

  • A link to the latest Summary of Changes is included:  Summary of Changes
  • Medica to add new UM policies for 2 new medical pharmacy Drugs – Effective August 1, 2022 -J0172 Aduhelm and J3590 Fylnetra
  • Medica to implement 2 new drug coverage policies – J0172 Aduhelm, J3285 Remodulin – Effective 09/22/2022
  • Upcoming changes to Medica Part D drug formularies – Effective August 1, 2022

Network News

  • Effective 10/01/2022 Medica will implement standard ancillary fee schedule updates for all Medica products. This will impact several areas and these can be viewed by following the link to the newsletter.

Administrative News

  • Provider administrative training webinar for August: Claim Appeals, Adjustments and Record Submission.  View the newsletter for details.

Medica August 2022 Newsletter

Cigna Network News – Third Quarter, 2022

July 29, 2022

This Quarter’s Featured Articles:

FEATURE ARTICLE

  • Virtual care services should now be billed with POS code 02

POLICY UPDATES

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

ELECTRONIC TOOLS

  • Register to receive InstaMed patient payments
  • Save time: Submit reconsideration requests and appeals online
  • Forgot your CignaforHCP.com user ID or password?
  • Tips for online reconsideration and appeals
  • Webinar schedule for digital solutions

CONNECTED CARE

  • Timely referrals: The important role of PCPs
  • Tips for rescheduling patient appointments

NETWORK UPDATES

  • Cigna + Oscar Health plans
  • Cigna Gene Therapy Program updates
  • CLINICAL NEWS
  • Providers are critical in maternal mental health screening

PHARMACY NEWS

  • Accredo Wellbeing Watch supports patients with depression and anxiety
  • Specialty Medical Injectables with Reimbursement Restriction

MEDICARE NEWS

  • 2022 Cigna Medicare Advantage plan highlights
  • Cigna Medicare Advantage COVID-19 updates
  • Bridging the Part D coverage gap
  • Extending your treatment plan for Medicare Advantage patients

GENERAL NEWS

  • Physician quality and cost-efficiency reconsideration requests due September 9
  • Ambulatory medical record review provider follow up
  • Healthmap Solutions: Enhanced support for chronic kidney disease
  • Order hearing devices from Amplifon, our exclusive national provider
  • Coordination of care
  • Industry insights: Navigating the transition to value-based care
  • Cigna quality resources and more
  • Social determinants of health CME training and resources
  • Medical record requests: Thank you for responding
  • Discounts for language assistance services

REGIONAL NEWS

  • Quarterly notification of Maryland nonparticipating specialists
  • California language assistance law
  • New Mexico language assistance law

HELPFUL REMINDERS

  • Market Medical Executives contact information
  • How to contact us
  • Updated reference guides and manuals
  • 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
  • Cultural resources you can use
  • Have you moved recently? Did your phone number change? ……….42
  • Get digital access to important information
  • Access the archives
  • Letters to the editor

Cigna Network News 3rd Quarter 2022

Cigna Reimbursement Policy Update – Physical Therapy, Occupational Therapy and Chiropractic Services

July 26, 2022

Effective October 15, 2022, Cigna will update their medical coverage and reimbursement policy related to physical therapy, occupational therapy and chiropractic services as follows:

 

  • Physical therapy, occupational therapy, and chiropractic claims for greater than four units (60 minutes) of timed service

The portion of a physical therapy (PT), occupational therapy (OT), or chiropractic claim that is greater than four units (60 minutes) of timed, short-term rehabilitation services per patient, per day, per provider will be denied as being not medically necessary.

 

  • Modifiers CO and CQ reimbursement reduction for physical or occupational therapy assistant services

Reimbursement for claims submitted with modifiers CO and CQ for services provided by a physical therapy (PT) or occupational therapy (OT) assistant will be reduced by 15 percent. This update more closely aligns with industry standards, including the CMS National Physician Fee Schedule, which reimburses these services at 85 percent.

 

Click the following link to view the complete announcement from Cigna.

Cigna – Reimbursement Policy – PT OT Chiropractic Services 101522

 

Upcoming Provider Trainings – Beacon Health Options

July 22, 2022

Please review this announcement for information on upcoming registrations for the month of August.  .

Upcoming webinars and the accompanying registration links are listed below. Registration is on a first come first serve basis. If you are unable to attend, the recorded webinars and related PowerPoint presentations will be posted here.

EXCLUSIVE TRAININGS FOR AUGUST

The following trainings have been offered by Beacon in the past, but do not occur on a monthly basis. If you haven’t had the chance to participate and have been wanting to, now is your time! Register before it’s too late!

Behavioral Health 101: A high-level overview of behavioral health definitions and practices. Training will define common behavioral health diagnoses like Bipolar, Schizophrenia, Major Depressive Disorders, and will provide statistics, background, common signs and symptoms associated

August 3 at 3 PM EST

Registration Link

Follow Up After Hospitalization/HEDIS Measure Overview: webinar will cover HEDIS measures for follow up after hospitalizations.

August 18 at 3 PM EST

Registration Link

Potential Quality of Care/Serious Reportable Events: webinar covers Potential Quality of Care (PQOC) concerns, including Serious Reportable Events (SREs) and reporting to Beacon Health Options.

August 18 at 4 PM EST

Registration Link

Dual Diagnosis: An introductory level training on Dual Diagnosis: the co-occurrence of substance use disorders and mental health disorders. This 1.5 hour course will cover definitions, statistics and warning signs of substance use and mental health disorders, as well as discuss potential causes and effects. It will also explore various treatment considerations including the importance of integrated screening and treatment. There is no CE credit or certification associated with this training.

August 24 at 3 PM EST

Registration Link

ProviderConnect Authorizations: This webinar is designed for providers and office staff who submit authorizations through ProviderConnect

August 31 at 2 PM

Registration Link

REOCCURING MONTHLY WEBINARS 

Claims Submission Guidelines: This live training provides an overview of billing and claims information and how to submit claims to Beacon Health Options along with reviewing best practices and avoiding claim denials.

August 10 at 2 PM EST

Registration Link

eServices Overview: webinar designed to provide an introduction and overview of the eServices platform for those health plans that use this portal. Topics covered include how to register, use, and submit claims and authorizations via eServices.

August 17 at 2 PM EST

Registration Link

ProviderConnect Overview: This webinar is intended for providers and office staff becoming familiar with ProviderConnect for the first time.

August 24 at 2 PM EST

Registration Link

InterQual for Providers: An overview of how to view and access Beacon’s Medical Necessity Criteria via InterQual.

August 25 at 1 PM EST

Registration Link

These webinars will be recorded and posted to Beacon Health Options Recorded Webinars if you are unable to attend the live session.

Telehealth Flexibility Period for Applied Behavior Analysis (ABA) Services – Optum Behavioral Health

July 20, 2022

Please see the announcement from Optum Behavioral Health.

On August 1, 2022, the telehealth flexibility period will end for Applied Behavior Analysis (ABA) services for Commercial membership and for Medicaid membership, if no state mandate was issued (state mandates take precedence).

The following services for which in-person care is evidence-based will no longer be covered when provided in a virtual modality:

  • Applied Behavior Analysis (ABA) service codes 97151, 97152, 97153, 97154, 97158, O362T, O373T presented virtually

Existing ABA caregiver training and technician supervision will continue to be permitted virtually for service codes: 97155, 97156, 97157.

Please refer to providerexpress for our ABA telehealth policy updates and FAQ’s.

We greatly value your participation in our network and thank you for the care you provide to members served by Optum.  Should you have any questions, please contact the Provider Service Line at 1-877-614-0484.

 

UPDATE: Cigna – Reimbursement Policy Update – E&M Codes Billed with Modifier 25 and Minor Procedures

July 15, 2022

Cigna recently announced an update regarding reimbursement for claims submitted with evaluation and management (E&M) Current Procedural Terminology (CPT®) codes
99212, 99213, 99214, and 99215 and modifier 25 when a minor procedure is billed.

They are currently reevaluating this reimbursement policy change, which will delay implementation.  Therefore, this policy will not go into effect on August 13, 2022, as originally planned.  They will communicate a new implementation and and details after their internal evaluation is complete.

Please click on the following link to view the complete announcement.

Cigna Reimbursement Policy Updates – Modifier 25 070622

UHC-KS Medicaid July Newsletter

July 13, 2022

The July 2022 UHC Kancare Newsletter is available below.

United Healthcare Community Plan of KS updates

TrackIt – a daily to-do list for your UHC claim related tasks.

TrackIt is an innovative tool on the UnitedHealthcare Provider Portal landing page that serves as your daily to-do list, your personal assistant, and an automatic reminder for all your UnitedHealthcare claim related tasks.

Need to upload a document? Are we missing some information to process your claim? TrackIt will tell you. No need to pick up the phone or wait for the mail. You can complete many actions without leaving the tool. TrackIt allows you to find information faster, save clicks and reduce unnecessary searches.

Make your workday more efficient and save time by checking TrackIt daily.

TrackIt ‒ A daily to-do list for your UnitedHealthcare claim-related tasks | UHCprovider.com

 

Spotlight on Common Denials

In this segment, we will discuss some of the most common denial reasons and provide tips to effectively reduce them.

Oddly enough, the most common denial we see as a payer, is the easiest to avoid. The most common denial across all provider types is CO-18: Duplicate claim/service. This happens when the claim is resubmitted without follow up.

How to avoid Duplicate denials:

  • Allow 30 calendar days from the receipt date for the claim to process
  • Check claim status before submitting another claim
    • Phone – UHC Provider Services: 1-877-542-9235
    • Online – UHC Secure Provider Portal: UHCProvider.com
      • Training opportunities mentioned in next section
    • Review EDI reports to verify which claims were received and accepted or rejected
      • Check with your clearinghouse if not familiar with these reports

Upcoming UHC-Kancare Training Opportunities

If you’re not familiar with UHC’s Provider Portal – there are 2 training methodologies to help you become proficient:

Instructor-led – Instructor-Led Learning Events | UHCprovider.com

Look for course entitled: Claims Overview

Self-paced – Digital Solutions | UHCprovider.com

Look for course entitled: Claim Follow Up Self-Paced User Guide

 

Kancare UHC 101 (Medicaid 101) is held the last Wednesday of every month from 11am – noon CST

This month’s webinar will be held on July 27th at 11:00am CST

Webinars are hosted by Mona Hull

 

KMAP News

Attention Ambulance Providers – Effective with dates of service on and after July 1, 2022, a new rate increase will be available for certain services. See KMAP Bulletin 22105 for more details.

Attention Behavioral Health Providers – Effective with dates of service on and after July 1, 2022, certain Behavioral Health Services (BHS) codes will have a rate increase. See KMAP Bulletin 22128 for full details.

The KMAP Coding Modifiers Table was last modified on June 28, 2022. This chart has been developed to assist providers in understanding how KMAP handles specific modifiers. It is imperative providers understand the importance of using these modifiers correctly. Improper coding could result in a delayed, denied, or incorrect payment for the service(s) submitted. United Healthcare Community Plan of Kansas is obligated to follow KMAP’s direction with regards to modifier usage.

 

Recent KMAP Bulletins

For a complete listing of bulletins, please reference KMAP Provider Bulletins

July bulletins

June bulletins

Healthy Blue Medicaid Contact Information

July 12, 2022

Healthy Blue Medicaid has provided this attachment which contains several phone numbers and links that will help you find the information you’re needing.  Also included on the attachment is the contact information for Barbara Wheeler who is the Behavioral Health Provider Experience Consultant.  Feel free to contact her with any behavioral health issues or concerns.

Healthy Blue Medicaid Contact Numbers

UHC Community Plan of Missouri OB Services – Wellhop for Mom and Baby

July 11, 2022

UHC Community Plan of Missouri has upcoming changes beginning 8/1/22 related to OB services.  The UHC provider advocate team wanted to host a learning session to review the upcoming changes and also provide information on Wellhop for Mom & Baby.

There are three meeting times available:  Wednesday July 20th 12:00 – 12:30 pm, Friday July 22nd 12:00 – 12:30 pm or Wednesday July 27th 9:00 – 9:30 am.  The meeting links are below.

Missouri: CPT® code changes for obstetrical services beginning Aug. 1, 2022 | UHCprovider.com

UHC MO Community Plan Wellhop Provider FAQ

Microsoft Teams meeting

Join on your computer or mobile app

Wednesday July 20th 12:00 – 12:30

Click here to join meeting

Friday July 22nd 12:00 – 12:30

Click here to join meeting

Wednesday July 27th  9:00 – 9:30

Click here to join meeting

Or join by entering a meeting ID
Meeting ID: 275 986 651 015
Passcode: wpDuiz

Join with a video conferencing device

Video Conference ID: 115 235 792 28

Alternate VTC instructions

Or call in (audio only)

+1 952-222-7450,,188302057#   United States, Bloomington

Phone Conference ID: 188 302 057#

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