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.

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

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 11^th  7:00 am-8:00 am:  https://bit.ly/3cBDlJR

OR

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

Essence-Creating a Referral- Tips

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

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

Please see the link below for the BCBS of IL September updates.

BCBS of IL – Blue Review (Sept 2022)

General New

• Medica encourages members to receive their flu vaccine. Additional information from the CDC related to seasonal flu vaccines available by following the link on the newsletter.

Clinical News

• Medical policies and clinical guidelines to be updated – Effective October 17, 2022: Updates to Medical Policies

Pharmacy News

• A link to the latest Summary of Changes is included:  Summary of Changes
• Medica to add new UM policies for 4 new medical pharmacy Drugs – Effective October 24, 2022 -J3490 Amvuttra, J9047 Kyprolis, J0897 Prolia/Xgeva and J3590 Skyrizi
• Be sure and review specific plan restrictions for the updates drug policies
• Upcoming changes to Medica Part D drug formularies – Effective September 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 September: Setup and Billing for Elderly Waiver and Housing Stabilization Providers. View the newsletter for details.
• The Provider Administrative Manual can be accessed by following the link on the newsletter.

Sept2022Conn – Final

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

As a reminder, we now recommend providers bill virtual care services using Place of Service (POS) 02. 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.

Additionally, when you bill POS 02, your patients may also pay a lower cost-share for the virtual services they receive due to a recent change in some plan benefits.

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.

Public health emergency period

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

Cigna – latest COVID-19 updates – August 2022

MO HealthNet will be offering brief webinars, which will cover Telemedicine

Please click the link below to view the Telehealth training schedule and to sign up to attend.

MO Healthnet- Telehealth Trainings 2022

Blue Review August 2022 Newsletter

BCBS of IL – Blue Review (Aug 2022)

Electronic Options

• New Online Option to Confirm Medical Record Receipt Status
• Check Eligibility and Benefits: Don’t skip this important first step!

Pharmacy Program

• Quarterly Pharmacy Changes Effective July 1, 2022 – Part 2
• Prior Authorization Changes Effective October 2022

Wellness and Member Education

• Share Facts About Immunizations with Your Patients in August

Community Involvement

• 2022 Back to School Events at Our Blue Door Neighborhood Center^SMLocations

Focus on Behavioral Health

• Behavioral Health Support Resources: Maternity Program for Blue Cross Community Health Plans^SM(BCCHP^SM) Members

Provider Education

• Provider Learning Opportunities
• Has your information changed? Let us know!

Claims and Coding

• New Laboratory Management Program to Begin Nov. 1, 2022
• Reminder: CPT^®Codes May Change

Claims and Coding

• Reviews on Inpatient DRG Claims for BlueCard^®(Out of Area) Medicare Advantage Members
• Illinois Medicaid Providers: Confirm Certifications and Licensure are Active in the IMPACT System

Clinical Updates, Resources and Reminders

• Medicaid Reminder: HFS Reinstatement of Certificate of Transportation Services (CTS) Form, Effective June 1, 2022
• Use Our New Prior Authorization Digital Lookup Tool for Medicaid Member Information

Quality Improvement and Reporting

• Blue Distinction^®Centers for Cancer Care