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.

United Healthcare Payer News Updates

February 02, 2023

Please follow the links for detailed updates to the items listed below.  Be sure and share with your staff that would benefit.

Radiation and Oncologic Procedures – Medicare Advantage Coverage Summary (uhcprovider.com)

Reconsideration and appeal submissions going digital | UHCprovider.com

Reconsideration and appeal submissions going digital | UHCprovider.com

Over 600k members to receive new ID cards | UHCprovider.com

Medicare cost-share changes begin Jan. 1, 2023 | UHCprovider.com

Network News | UHCprovider.com

Know more about NexusACO plans | UHCprovider.com

 

Department of Veterans Affairs Community Care Network educational session invite

February 02, 2023

Physicians, Practice Managers, and Staff,

Welcome to the Department of Veterans Affairs Community Care Network (VA CCN). You are invited to attend a Veterans Affairs Community Care Network Overview educational session.

Join us for one of the following virtual one hour educational presentations to learn more about VA CCN, treating Veterans and doing business with VA and Optum.

During this webinar we will discuss:

  • VA CCN Overview
  • Referrals and Appointment Scheduling
  • Providing and Coordinating Care
  • Medical Documentation Requirements and Claims
  • Where to locate additional resources

Registration is required and space is limited. Please register for one of the sessions below by clicking the link for the day you can attend.

Date Microsoft Teams Registration Link
Monday February 6th, 2023

11:00 a.m. CST

Click here to register
Monday February 13th, 2023

11:00 a.m. CST

Click here to register
Monday February 20th, 2023

11:00 a.m. CST

Click here to register
Monday March 6th, 2023

11:00 a.m. CST

Click here to register
Monday March 13th, 2023

11:00 a.m. CST

Click here to register
Monday March 20th, 2023

11:00 a.m. CST

Click here to register

Take advantage of VA CCN Training and Resources

Be sure to check out our new Veterans Affairs Community Care Network (VA CCN) Resources page on Provider Express.

If you have questions regarding this network, please call our VA CCN Provider Services at 1-844-839-6108.

Thank you for supporting our nation’s heroes.

Adam T. Pancake, LPC
Manager – VA CCN Provider Advocacy
Optum Provider Services

Anthem Provider Newsletter – February, 2023

February 01, 2023

Anthem Provider Newsletter – Missouri February 2023

This month’s featured articles

Administrative:

  • Controlling High Blood Pressure and Submitting Compliant Readings
  • AIM Specialty Health will transition to Carelon Medical Benefits Management Inc.
  • Have you reviewed your online provider directory information lately?
  • Do you offer telehealth services? Let us know!

Digital Tools:

  • Enhancing Provider News website and email communications
  • Helping to reduce delays when submitting attachments: Make sure your correspondence includes one of these elements

Medical Policy & Clinical Guidelines:

  • Medical Policies and Clinical Guidelines updates – February 2023
  • AIM Specialty Health Cardiology Clinical Appropriateness Guidelines CPT Code List update
  • Updates to AIM Specialty Health Advanced Imaging Clinical Appropriateness Guidelines

Pharmacy:

  • Specialty pharmacy updates – February 2023

Federal Employee Plan (FEP):

  • 2023 FEP benefit information available online

Medicare:

  • Name change announcement: myNEXUS will transition to Carelon Post Acute Solutions on March 1, 2023
  • Keep up with Medicare News – February 2023

Cigna – Medical coverage policy update – Peripheral Nerve Block Procedures

January 31, 2023

Cigna – Coverage Policy Update – Peripheral Nerve Block Procedures 041623

Cigna routinely reviews their coverage, reimbursement, and administrative
policies for potential updates.  As a result of a recent review, they implement the following medical coverage policy updates.

  • We will deny claims for peripheral nerve block procedures billed with Current Procedural Terminology (CPT®) codes 64505, 64400, and 64405 as experimental, investigational, or unproven (EIU) regardless of the diagnosis.
  • CPT code 64450 will be denied as EIU only when submitted with a headache and/or trigeminal/occipital neuralgia diagnosis.
  • This update is effective for dates of service on or after April 16, 2023.

Anthem Important reminder: New ID cards for many of our Anthem Blue Cross and Blue Shield members

January 20, 2023

Many members received new ID cards with a new ID and new group number.

Be sure to request these new ID cards from our members to update your records with this
new member information.

This new ID number is required to verify eligibility and benefits.

Through our secure portal Availity.com*, you can easily get answers to your questions
about, claim status, eligibility, and benefits. You can also retrieve electronic remits, make
provider demographic changes, and complete your pre-authorization inquiries.

If you are not an Availity user, visit www.availity.com to register today. It’s safe, secure,
and easy to use!

To contact our Provider Service team, please call the Provider Service toll free number
located on the back of the member’s new ID card.

Anthem Reminder – New ID Cards for 2023

Anthem Provider Newsletter – January, 2023

January 03, 2023

Anthem Provider Newsletter – Missouri January 2023

This month’s featured articles:

Administrative:

  • Professional system updates for 2023
  • Outpatient system updates for 2023
  • Notification regarding reimbursement changes to COVID-19 laboratory services codes
  • Engagement with your patient counts
  • Childhood Immunization Status and Lead Screening in Children for HEDIS
  • Remittance advice message enhancements: Providing clear descriptions and actionable next steps

Digital Tools:

  • Submitting prior authorizations digitally through Interactive Care Reviewer

Reimbursement Policies:

  • Outpatient facility revenue code billing requirements

Medical Policy & Clinical Guidelines:

  • Updates to AIM Specialty Health Rehabilitative and Habilitative Services Clinical Appropriateness Guidelines
  • Update: AIM Specialty Health Cardiology Clinical Appropriateness Guidelines CPT Code List
  • AIM Specialty Health Cardiology Clinical Appropriateness Guidelines CPT code list update
  • Updates to AIM Specialty Health Radiation Oncology Clinical Appropriateness Guidelines
  • Updates to AIM Specialty Health Musculoskeletal – Interventional Pain Management Clinical Appropriateness Guidelines
  • Updates to AIM Specialty Health Cardiac Clinical Appropriateness Guidelines – Material adverse change

Pharmacy:

  • Specialty pharmacy updates

Medicare:

  • Keep up with Medicare news – January 2023
  • Cleveland-Cliffs offers Medicare Advantage option

Federal Employee Plan (FEP):

  • Federal Employee Program observation conversion for musculoskeletal cases