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 – Medicare Prior Authorization

November 18, 2022

List Effective January, 2023

Wellcare and Wellcare by Allwell require prior authorization (PA) as a condition of payment for many services. This Notice contains information regarding such prior authorization requirements and is applicable to all Medicare products offered by Wellcare and Wellcare by Allwell.

Wellcare and Wellcare by Allwell are committed to delivering cost effective quality care to our members. This effort requires us to ensure that our members receive only treatment that is medically necessary according to current standards of practice. Prior authorization is a process initiated by the physician in which we verify the medical necessity of a treatment in advance using independent objective medical criteria and/or in network utilization, where applicable.

It is the ordering/prescribing provider’s responsibility to determine which specific codes require prior authorization. 

Please verify eligibility and benefits prior to rendering services for all members. Payment, regardless of authorization, is contingent on the member’s eligibility at the time service is rendered. NON-PAR PROVIDERS & FACILITIES REQUIRE AUTHORIZATION FOR ALL HMO SERVICES EXCEPT WHERE INDICATED.

For complete CPT/HCPCS code listing, please see Online Prior Authorization Tool on our website at: https://www.wellcare.com/en/Missouri/Providers/Bulletins and  https://www.homestatehealth.com/providers/allwell-provider-materials.html

Cigna – Digital ID Card Information

November 18, 2022

Cigna – Digital ID Cards

Cigna has shared the following information regarding their increased use of digital ID cards.

Starting in 2022 you will be seeing more members with Digital ID Cards.  You might have received an email with the same information.  To ensure all correct team/contacts received the information I am sending it out again.

Cigna continues to leverage the power of technology and data to accelerate its transition to fully adopt digital-only ID cards* by 2024. This approach to digital ID cards is the next step in our journey to offer more digital-first solutions for our customers and providers.

What this means to you
Digital ID cards are not new for Cigna or the industry overall. Over the past several years, you may have noticed patients starting to present their ID cards to you in a digital format – typically on their phone from the myCigna® app or from the myCigna.com® website. This experience for you and your front-office staff should not change.

However, you may start to see more patients who have a digital-only ID card beginning in 2023. As they do today, your patients will have the option to:

Share their digital ID card image on a phone screen in your office
Relay the information verbally over the phone to preregister for their appointment
Upload a digital ID card image to your health portal (as technology allows)
Email the digital ID card image directly to your office from the myCigna app
Print a copy of their digital ID card and share it with your office

 

Importantly, please note the digital ID card will look the same as the physical ID card does today and will contain the same benefit information.

If the member does not have access to a smart phone or computer.  Your office staff can always look up the digital card on CignaforHCP.com.  You are able to search by the members first and last name with their Date of Birth.

SumnerOne, Inc Direct Contract Termination Notice

November 17, 2022

Effective 12/31/2022 SumnerOne, Inc will be terming their direct contract with Mercy. We have been advised that they will be moving to the UnitedHealthcare Core Network effective January 1, 2023.

****Keep in mind that the Mercy North Central region-which includes the Springfield, Joplin and Rolla area-is out of network with the UHC Core plan.******

UnitedHealthcare 2023 Individual Exchange plans

November 17, 2022

Beginning January 1st, 2023 UnitedHealthcare will be offering a new Individual Exchange plan in the North Central and East markets. Our Mercy providers will be enrolled.

They have provided a link to the Individual Exchange plan which I have added below as well as link to the Quick Reference Guide.  The Reference Guide provides a wide range of information including a sample ID card, where to find eligibility and benefit information, as well as claim submission information.  You will also find several links on the Plan Page.

Please review and ensure your staff is aware.

UHC Individual Exchange Plan Page

Quick Reference Guide

Home State Health – Clinical and Payment Policy Updates

November 14, 2022

HSH Clinical and Payment Policy Updates 111422

Home State Health has announced that they will be implementing the following clinical and payment policy updates.  Please click on the link above to view the complete announcement.

  • Biopsychosocial Treatment of Obesity
  • Pulmonary Function Testing

You are invited: Healthy Blue Medicaid FUH Initiative Virtual Provider Munch & Learn

November 14, 2022

Please review the announcement from Health Blue Medicaid regarding several interactive sessions they’re hosting related to the Follow-Up After Hospitalization (FUH) Collaboration initiative.  This is primarily geared towards Behavioral Health providers and additional details and registration information can be found on the attachment.

 

Attached is an invitation for upcoming interactive Munch and Learn sessions that Healthy Blue MO will be hosting to educate behavioral health providers about the MHD Follow-Up After Hospitalization (FUH) Collaboration initiative.  Should you would like to participate please follow the directions on the flyer by sending a email to the mailbox indicated but be sure to put this in the subject line: FUH Initiative Virtual Provider Munch & Learn to insure that you register for the correct series.

Please share this invite with any and all associates within your organization that would benefit from these sessions including leadership, providers, behavioral health clinical staff, discharge coordinators, etc.

 

HEALTHY BLUE SPONSORED BH PROVIDER MUNCH LEARN

Healthy Blue Medicaid Professional Rates***Update***

November 10, 2022

Please review the update from Healthy Blue Medicaid regarding the rate changes and claim payment disputes.

Healthy Blue would like to provide you with information regarding the professional fee schedule rate updates that were effective 7/1/22. Although state bulletins were recently published with increased rates that were retro-effective 7/1/22, please note that the updates were still pending CMS approval. As a health plan, Healthy Blue could not implement the rate increases without CMS approval, which is why claims have continued to pay the old rates.

 

CMS has since approved the rates, and the approved fee schedules were published on the state’s site on 10/31/22. Currently, Healthy Blue is diligently working on auditing the updated fee schedules and loading them into our claims processing system. Once this is complete, Healthy Blue will reprocess incorrectly paid claims from 7/1/22 to pay the updated rates. Please discontinue submitting claim payment disputes regarding the updated rates as Healthy Blue will be reprocessing all incorrectly paid claims upon system update.

Cigna – COVID-19 Public Health Emergency Period Extended Through January 11, 2023

November 09, 2022

Public health emergency period extended through January 11, 2023

Since the COVID-19 pandemic began, Cigna has taken important
steps to deliver timely accommodations to providers and customers,
helping to ensure that customers have continued access to COVID-
19 diagnostic services, testing, and treatment in safe settings.

To align with the recent extension of the federal public health
emergency (PHE) period, Cigna is again extending the cost-share
waiver for diagnostic COVID-19 testing and testing-related services
through January 11, 2023 for individuals with Cigna commercial and
Cigna Medicare Advantage benefit plans.

Click on the link above to view the entire announcement.

Medica – November 2022 Connections Newsletter

November 01, 2022

General News

  • Medica will have a new 6-tier formulary with the addition of a Preferred Generic tier.

Clinical News

Pharmacy News

  • A link to the latest Summary of Changes is included:  Summary of Changes
  • Be sure and review specific plan restrictions for the updates drug policies
  • Upcoming changes to Medica Part D drug formularies – Effective January 1, 2023

Network News

  • Effective 01/01/2023 Medica will implement standard 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

  • The Provider Administrative Manual can be accessed by following the link on the newsletter.

November 2022Connections

United Healthcare Provider News 11/2022

November 01, 2022

Please follow the link below to view the November 2022 Provider News from United Healthcare.

2022 United Healthcare Provider News

There are various policy and protocol updates for commercial, Medicare and Medicaid with effective dates ranging from 11/01/2022 – 01/01/2023.

There are no state specific updates for our regions.

Included is a reminder and additional information related to the move to digital reconsideration and post-service appeals.

Be sure to review the updates closely as not all will apply to our region.