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.

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.

Public health emergency period extended through April 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 April 11, 2023, for individuals with Cigna commercial and
Cigna Medicare Advantage benefit plans.

Click on the link above to view the entire announcement.

General News

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

Clinical News

• Medical policies and clinical guidelines to be updated – Effective December 19, 2022: Updates to Medical Policies

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

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.

Anthem Provider Newsletter – Missouri November 2022

This month’s featured articles

Administrative:

• CAA: Keep your provider directory information up to date
• Support documentation for AIM prior authorization requests

Digital Tools:

• Claims status message enhancements: providing clear descriptions and actionable next steps
• Submit digital attachments within seven-calendar days for claims filed with a PWK segment indicator
• You can now submit one electronic claim dispute for multiple claims and access correspondence digitally, too
• Visit the Provider Learning Hub to view our latest learning opportunities
• Remote EMR access service for HEDIS

Pharmacy:

• Specialty pharmacy updates – November 2022

Medical Policy & Clinical Guidelines:

• Medical policy and clinical guideline updates – November 2022
• Transition to AIM Specialty Health Perirectal Hydrogel Spacer for Prostate Radiotherapy Clinical Appropriateness Guideline

Reimbursement Policies:

• Outpatient Prepay Itemized Bill Review Program update – Facility
• New reimbursement policy: Place of Service – Facility

Medicare:

• Keep up with Medicare News – November 2022
• Anthem Blue Cross and Blue Shield expands specialty pharmacy precertification list
• Personalized Match

Click on the link for important information on FLUVENTION 2022.

FLUVENTION

HealthChoice Network News October 2022

In this issue

• CBC code removal
• Mammography
• Update to contract language
• Update to limitations
• Fee schedule updates
• Contact information

Cigna Network News 4th Quarter 2022

This quarter’s articles:

FEATURE ARTICLE

• com claim search enhancement

POLICY UPDATES

• Clinical, reimbursement, and administrative policy updates
• Precertification updates

ELECTRONIC TOOLS

• EFT enhancement: Enroll and manage on one screen
• Speed up common procedure code benefit lookups: New feature
• Message Center and claim status notifications coming soon
• Webinar schedule for digital solutions

NETWORK UPDATES

• New relationship with EyeMed for routine vision services
• Your care may be in-network under a strategic alliance plan
• Cigna + Oscar Health plans
• Cigna Gene Therapy Program updates

CLINICAL NEWS

• Tobacco cessation campaign

PHARMACY NEWS

• Changes in drug formulary effective January 1, 2023
• Home Infusion with Accredo
• Specialty Medical Injectables with Reimbursement Restriction

MEDICARE NEWS

• 2022 Cigna Medicare Advantage plan highlights
• Meet your Medicare Advantage Market Medical Executives
• Cigna Medicare Advantage COVID-19 updates
• Extending your treatment plan
• Single website coming for Cigna Medicare Advantage and commercial medical providers
• Bridging the Part D coverage gap

GENERAL NEWS

• Kaiser Permanente members to access Cigna PPO providers for emergency care
• 2023 Cigna Centers of Excellence displays
• Physician quality and cost-efficiency reconsideration requests
• Virtual Care Reimbursement Policy Oncology clinical consult service
• eviCore: Save time, submit precertification requests online
• Orthotics and prosthetics provider network to transition to eviCore
• Cigna Pathwell Specialty update: Ordering infusion services
• Diabetic retinal eye exam CPT II coding reminder
• Resources to support your care of Hispanic and Latino patients with diabetes
• Mitigating mental health stigma with culturally responsive care
• Updated LifeSOURCE provider reference guide
• Patient concerns or complaints

REGIONAL NEWS

• California provider directory update requirement
• California HMO provider appointment availability
• Adverse childhood experiences training for California providers
• California Language Assistance Program updated training Maryland nonparticipating specialists: Third-quarter notification

Please click the link for details regarding Mercy and Epworth Children & Family Services direct contract in place.

Epworth Direct to Employer memo UDPDATED 10-10-22

HOME STATE HEALTH PROVIDER NEWSLETTER

Home State Health – Connected in Care 2022 Newsletter

Welcome to Connected in Care from Home State Health, our newsletter developed specifically for providers with a focus on helping get the right care, in the right place, at the right time. Even as the prevalence of COVID-19 diminishes, we can still feel the effects of the pandemic on the healthcare system and on our world around us. Although we are slowly returning to a state of normalcy, there is still work to be done in assisting others to gain access to care.

In this issue, we will discuss the ways in which Home State Health, providers, care managers, and other healthcare professionals are working to close the care gaps in our system and provide better outcomes for everyone. We’ll also be looking at the importance of health equity in relation to HEDIS and the essential support that the Start Smart for Your Baby® program offers new and existing parents. Without your continued dedication, many would struggle to get the support they need. And for that, we thank you. We hope these resources help to continue closing the gaps in healthcare, and to better serve you in the fantastic work being done for our members.

Together, we are all connected in care.