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

Epworth Direct to Employer memo 10-10-22

Effective 12/01/2022 Healthy Blue will update its policy related to Anatomical Modifiers to align with CMS guidelines as well as national benchmarks and industry standards.

Please review the attachment for instructions and a list of the modifiers to be used.

Healthy Blue Anatomical Modifier Provider Communication

The Newsletter can be accessed by following the link below

Healthy Blue Medicaid October 2022 Newsletter

Included in this issue you’ll find information related to Monkeypox including symptoms, treatment, etc.

Details regarding the retraction of a policy entitles Sexually Transmitted Infections Testing – Professional.

Information and overview of a smoking cessation resource available to members.

Effective November 14, 2022, the direct agreement between Mercy and Integrity Home Care will terminate. On this date, their employees will move to a plan through Bayada accessing the Aetna provider network.

Please make sure that you request to see new identification cards when employees of this group present for care.

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 – 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

HealthChoice Network News – Fall 2022

In this issue

• HealthChoice TPA changing to UMR in 2023
• Certification and claim appeals for medical and dental services
• HealthChoice EDI payer IDs and new group numbers
• Codes requiring review
• HealthChoice claim remittance vendor change
• Contact information

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).

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?

Please click on the link below to see all October 2022 Medica updates.

Medica- October 2022 Updates and News