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.

Department of Veterans Affairs Community Care Network Region 3 Educational Sessions

October 03, 2022

Please review the attachment regarding training sessions offered by Optum/UHC for the Veterans Affairs Community Care Network (VA CCN).  These are being hosted by Region 3 which includes Arkansas and Oklahoma but will contain useful information for all Regions.  The sessions are one hour in length and registration information can be accessed by following the link on the attachment.

VA_CCN_R3_Training_Oct-Dec 2022_BH4365a

 

Anthem Provider Newsletter – October 2022

October 03, 2022

Anthem Provider Newsletter – Missouri October 2022

This month’s featured articles:

Administrative:

  • Monkeypox and smallpox vaccines: Product code on claims
  • The Provider Learning Hub is here
  • Guidance for coding evaluation and management services for new and established patients
  • Signature requirements for laboratory orders or requisitions
  • CAA: Review your online provider directory information

Digital Tools:

  • Learn how Interactive Care Reviewer makes it easy to submit authorizations electronically
  • New Strategic Provider System implementation in August 2022

Pharmacy:

  • IngenioRx will become CarelonRx on January 1, 2023
  • Specialty pharmacy updates – October 2022
  • Pharmacy information available on provider website

Reimbursement Policies:

  • Reimbursement policy update: Multiple and Bilateral Surgery Processing – Professional
  • Reimbursement policy update: Three-Dimensional (3D) Radiology Services – Professional and Facility

Federal Employee Plan (FEP):

  • Availity Essentials provider chat – a fast, easy way to get your UM questions answered for Federal Employee members

Medicare:

  • Keep up with Medicare News – October 2022
  • Reimbursement Policy Retraction: Sexually Transmitted Infections Testing – Professional
  • Courtesy notification of specialty pharmacy medical step therapy updates

Home State Health – Provider News Reminder – 9/27/2022

September 28, 2022

Home State Provider News – 092722

Home State Health reminds providers to regularly update and certify provider data in CMS’s National Plan & Provider Enumeration System (NPPES).

Arkansas Blue Cross Blue Shield – Providers’ News September, 2022

September 27, 2022

ABCBS Provider News – September 2022

This month’s featured articles…

Arkansas Blue Cross and Blue Shield

  • 2022 Open Enrollment – Please use Availity
  • Annual compliance training
  • Air ambulance policy
  • Ground ambulance policy
  • Benefit certificate updates
  • Coverage policy manual updates
  • CMS requirement for provider certification on National Plan and Provider Enumeration System (NPPES)
  • Finding hidden chronic kidney disease (CKD)
  • Full Independent Practice for Certified Nurse Practitioners
  • Health Advantage pricing changes
  • High Deductible Health Plans and Health Savings Accounts
  • Injectable medication fee schedule
  • Medical specialty medications prior approval update
  • Pharmacy Update
  • Provider availability and accessibility
  • Primary Care Programs
  • Provider Data Management implementation
  • Postponing go-live date for utilization management platform & submission
  • Two-Day turnaround times for prior approval responses not applicable to self-funded groups
  • Standard formulary changes effective October 1, 2022
  • Value Formulary Changes Effective 10/1/2022
  • Metallic formulary changes effective October 1, 2022

Arkansas School & State / Public School Employees

  • Change for some ASE/PSE retirees

Federal Employee Program (FEP)

  • FEP adds new policy for low back pain imaging studies
  • Testosterone Review

Medicare Advantage

  • Medicare Advantage genetic testing prior authorization reminder
  • Reminder on billing qualified Medicare beneficiaries
  • Requirements for outpatient observation care

Blue & You Fitness Challenge

  • Important Deadlines for 2023 Challenge
  • What is the Blue & You Fitness Challenge?

Cigna – Covid 19 – September Update

September 22, 2022

Reimbursement update for COVID-19 antibody treatment bebtelovimab

Throughout the pandemic, the emergency use authorized monoclonal antibody drug bebtelovimab was purchased by the federal government and offered to providers for free. As a result, we did not reimburse for the drug itself when billed with Q0222.

However, on August 15, drug manufacturer Eli Lilly started commercial distribution of their COVID-19 monoclonal antibody therapy, bebtelovimab (175 mg), and the federal government will no longer purchase it. Therefore, effective with August 15 dates of service, Cigna will reimburse providers consistent with the Centers for Medicare & Medicaid Services rates for doses of bebtelovimab that they purchase directly from the manufacturer. Reimbursement for the administration of the injection will remain the same.

Reimbursement rates are as follows:

  • Q0222 (175mg for the drug): $2,394
  • M0222 (administration in facility setting): $350.50
  • M0223 (administration in home setting): $550.50

 Virtual care billed by urgent care centers

As a reminder, we stopped reimbursing virtual care services provided by urgent care centers on March 13, 2022 when billed with a global S9083 code. However, due to feedback received from urgent care centers, we resumed reimbursing urgent care centers for virtual care services billed with a global S9083 code for all dates of service, effective August 13, 2022.

Virtual care services provided by urgent care centers with code S9083 that were that were denied between March 13, 2022 and August 13, 2022 will be automatically reviewed and adjusted to be covered, as applicable. Claims that are reimbursable as part of that review will be automatically reprocessed to pay. There is no action needed by urgent care centers to have claims reviewed, reprocessed, or reimbursed.

 Virtual care place of service requirement reminder

We now recommend providers bill virtual care services using place of service (POS) 02 in support of a recent change in some plan benefits that could reduce your patients’ cost-share for virtual care. Please note that we recently updated our systems to ensure providers receive 100 percent of face-to-face reimbursement for covered virtual care services when using POS 02.

Please also note that we continue to request that providers do not bill POS 10 (or Modifiers 93 or FQ) for virtual care at this time. While POS 10 should not be denied nor reduce reimbursement, it will not reduce your patients’ cost-share.

COVID-19 testing

As a reminder, to align with the current end date of the federal public health emergency (PHE) period, the cost-share waiver for diagnostic COVID-19 testing and testing-related services is in place through October 13 for individuals with Cigna commercial and Cigna Medicare Advantage benefit plans.

Finally, please note that the federal government recently announced that they suspended taking orders for free COVID-19 tests through COVIDTests.gov. This initiative previously allowed all households to order three sets of four at-home test kits with no cost. The last day for individuals to have placed new orders was September 2, 2022.

Cigna – Covid 19 – September Update

 

Essence- Lifting all Waivers eff 10/15/22, Reinstating Referrals

September 14, 2022

CMS has given health plans the ability to lift the State of Emergency waivers based on what is happening in their service areas. Based on that directive Essence will lift all waivers as of October 15, 2022 and thus will be reinstating referrals.  We realize that a lot of offices are still engaged in the referral process, however Essence will be providing referral training webinars simply as a re-fresher for existing PCP staff and training for new staff.

As a reminder Essence believes that the Primary Care Physician (PCP) should coordinate the member’s medical care in totality.  The PCP is responsible for ensuring the member receives both appropriate and necessary medical care to prevent complications and manage the member’s overall health.  The referral is the tool that outlines and communications the PCP’s instructions regarding approved services.  A referral is required for all specialist visits, home healthcare or outpatient therapy.  A referral can only be entered by the PCP office.  The referral will identify a date range for which the services are valid, the number of visits, along with the level of service authorized.

Below are the dates and links for the trainings. Pre-registration is not required.  We hope to see you there!!

Tuesday, October 11th  7:00 am-8:00 am:  https://bit.ly/3cBDlJR

OR

Thursday, October 13th 12:00 pm-1:00 pm:  https://bit.ly/3Qg91Co

Essence-Creating a Referral- Tips

Humana/Cohere to Expand Authorization Program

September 14, 2022

Effective 01/01/2023 the Humana and Cohere partnership will be expanding Ministry-wide to accept cardiovascular and surgical services.

**Please note Mercy Hospital Springfield and Mercy Hospital St Louis will be piloting this program and it will roll out to these facilities on 10/01/2022.**

You can follow the first link below to register for one of Cohere’s webinar programs specific to this expansion.  The second link will direct you to a listing of “Getting Started with Cohere” courses if you would like more in-depth instruction. We do ask that you share this with your authorization/pre-cert team as well as any decision makers over those areas.

Cohere Webinar Registration

Getting Stated with Cohere

We’ve also attached a one page print-out that reviews the update and steps to take as well as a copy of the welcome packet.

Cardio & SS One-Pager for Providers, June 2022

Cohere-Welcome-PacketCohere-Welcome-Packet Cardio & SS One-Pager for Providers, June 2022

Anthem Provider Newsletter – Missouri September 2022

September 09, 2022

This month’s featured articles:

Administrative:

  • Continuing to Explore the Intersection of Race and Disability
  • Monkeypox resources and recommendations for our care providers
  • Important information about women’s preventive care visits
  • Correction: New patient evaluation and management services when reported for the same patient within the last three years
  • Reminder to submit claims with complete and correct data to avoid claim denial
  • Drug code billing reminder
  • CAA: Current provider directory information is key for members and providers to engage with you seamlessly
  • Anthem to accept Hospital in Home services

Digital Tools:

  • New Digital Provider Enrollment tool added to Availity
  • Updates to the Claim Attachment workflow

Products & Programs:

  • New Back Pain Management Program

Pharmacy:

  • Update to formulary lists for Commercial health plan pharmacy benefit
  • Specialty pharmacy updates – September 2022

Medical Policy & Clinical Guidelines:

  • Medical policy and clinical guideline updates – September 2022

Reimbursement Policies:

  • Reimbursement policy update: Modifier Rules – Professional
  • Reimbursement policy update: Assistant at Surgery (Modifiers 80, 81, 82, AS) – Professional 30 Reimbursement policy update: Modifier 66: Surgical Teams – Professional

Federal Employee Plan (FEP):

  • OBRA 93 claim filing for Federal Employee Program

Medicare:

  • Keep up with Medicare News – September 2022
  • Reminder: AIM prior authorization phone number change for Medicare
  • Prior authorization requirement changes effective December 1, 2022
  • Anthem expands specialty pharmacy precertification list
  • Reimbursement policy update: Modifiers 25 and 57 – Evaluation and Management with Global Procedures
  • Enhancing claims attachment processes through digital applications

September 2022 Anthem Provider… – pub1484