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.

Healthy Blue – Clinical Alert: CT Contrast Shortage

May 18, 2022

Radiology Program

AIM has been made aware of a possible temporary iodinated contrast shortage, specifically involving GE Healthcare’s iodinated contrast media (Omnipaque™) stemming from a manufacturing facility lockdown in Shanghai, China. Iodinated contrast is used to provide enhancement of organs, tissues, and blood vessels for CT scans. GE estimates an 80 percent reduction in the supply of Omnipaque for about 6–8 weeks.

What is AIM doing to address the contrast shortage?

For indications that cannot be adequately imaged by non-contrast CT, alternative advanced imaging modalities may be appropriate. Many AIM guideline indications have allowances for MRI and/or PET/CT “when CT cannot be performed or is non-diagnostic,” which would include scenarios such as this when contrast CT cannot be performed (and non-contrast CT is expected to be non-diagnostic).

Requests for alternative imaging made under such circumstances should include this detail (eg “iodinated contrast for CT is not available”) in the submitted prior authorization request, either by peer-to-peer discussion or via the free text entry option for online web portal requests.

Healthy Blue- ClinicalAlert- CTContrastShortage

Cigna: New Reimbursement Policy: Unacceptable Principal Diagnosis Codes

May 18, 2022

On August 13, 2022, Cigna will implement a new reimbursement policy, Unacceptable Principal Diagnosis Codes (R38), for claims billed with an unacceptable principal diagnosis code.  Unacceptable principal diagnosis is a coding convention in ICD-1O.  Those identified codes do not describe a current illness or injury, but a circumstance which influences a patient’s health status. These codes are considered to be unacceptable principal diagnosis codes.

Please review the attached announcement from Cigna for complete information.

Cigna – Reimbursement Policy – Unacceptable Principal Diagnosis Codes 081322

Wellcare/Wellcare by Allwell – Medicare Prior Authorization

May 17, 2022

Wellcare/Wellcare by Allwell has released the following notice regarding changes to their prior authorization policy effective July 1, 2022.

allwell authorization updates 070122

 

Claims Administrator Change: Commerce Bank

May 13, 2022

Effective May 1, 2022, the employer group Commerce Bank will change their claims administrator from HealthScope Benefits to UMR. They will continue to access the Mercy network through their direct agreement.

As a result of this change, Commerce Bank employees have been issued a new identification card with the new identification and claims submission information. A sample of the identification card is attached below.

Commerce Bank

Claim Address: UMR

PO Box 30541

Salt Lake City, UT 84130-0541

Payor ID #: 39026

Claims & Eligibility (Member): 800-826-9781

Claims & Eligibility (Providers):  877-233-1800

Commerce Banchares, Inc- BP001 – PPO Plan, Med 3-22-22

UnitedHealthcare – Home Health Update eff 6/1/22

May 10, 2022

UnitedHealthcare and naviHealth Partner in Arkansas, South Carolina, and Texas for home health authorizations

Beginning June 1, 2022, naviHealth will begin managing home health prior authorizations for UnitedHealthcare (Medicare Advantage and D-SNP) members in the states of Arkansas, South Carolina and Texas.

Please join us for an informational session where naviHealth will explain new workflows and processes for members requiring home health services.

Mission-critical training topics include:

  • Home health utilization management goals and workflow
  • Overview of our online portal (nH Access)
  • How to access agency resources

This session is intended for home health agency:

  • Administrators
  • Authorization managers
  • Claims and billing specialists
  • Clinical services directors
  • Intake directors

To register, click the link for your preferred date and time below. Space is limited so sign up early!

Tuesday, April 19, 11 am – 12 pm CT

Wednesday, April 20, 1 pm – 2 pm CT

Thursday, April 21, 4 pm – 5 pm CT

Tuesday, April 26, 2 pm – 3 pm CT

Wednesday, April 27, 10 am – 11 am CT

Thursday, April 28, 12 pm – 1 pm CT

Note: The home health prior authorization policy announcement can be found on UHCProvider.com. You can request additional information by visiting naviHealth.com/implementations

 

UnitedHealthcare – Home Health Update Eff 6-1-2022

BCBS of IL – May 2022 News and Updates

May 10, 2022

May 2022- BCBS of IL News and Updates

Articles in this issue:

Electronic Options

  • Telehealth Information for Provider Directories: What We’re Collecting and How to Make Updates

Claims and Coding

  • Telehealth Update: Using Place of Service (POS) Codes on Commercial Claims
  • Coding Update: Breast Augmentation and Removal for Gender Affirming Surgery
  • Postponed: New Lab Policies and Laboratory Benefit Management Program
  • BCCHPSMBilling Update for Manually Priced Durable Medical Equipment (DME) Devices (B4160 and B4161)

Clinical Updates, Resources and Reminders

  • Government Programs Prior Authorization (PA) Update: Code Changes, Effective July 1, 2022

What’s New

  • New Medication Delivery Program Offers Dose-packaging for Medicaid Members

Pharmacy Program

  • Pharmacy Program Updates: Quarterly Pharmacy Changes Effective May 1, 2022 – Part 2
  • Pharmacy Program Updates: Prior Authorization Changes Effective June 2022 and July 2022 – Part 2

Wellness and Member Education

  • Help Your Patients Keep Their Illinois Medicaid Benefits

Community Involvement

  • Free Programs at Blue Door Neighborhood Centers for Mother’s Day, Mental Health Awareness Month and National Physical Fitness and Sports Month

Focus on Behavioral Health

  • Your Patients’ Wellness Can’t Wait
  • Follow-Up Care for Substance Abuse Disorders

Quality Improvement and Reporting

  • Supporting Care During and After Pregnancy

Provider Education

  • Provider Learning Opportunities

Notification and Disclosure

  • Medical Policy Updates

BCBS of IL – Blue Review (May 2022)

***CORRECTION***Healthy Blue Medicaid New OBS/OP Admission Precertification Requirements

May 05, 2022

Please view this announcement from Healthy Blue Medicaid.

Healthy Blue continues to be dedicated to delivering access to quality care for our members, providing higher value to our customers and helping improve the health of our communities. Healthy blue has recently identified a system configuration issue with observation authorizations, that are incorrectly auto approving for 2 days if the request is completed via our phone intake system.

The struck-through paragraph has been replaced with this wording.

In an ongoing effort to promote accurate precertification submissions, until further notice, Healthy Blue will no longer allow precertification for observation stays to be requested over the phone, and they will only be accepted by submission via the portal or via fax. 

In an ongoing effort to promote accurate precertification submissions, until further notice, Healthy Blue will no longer allow precertification for observation stays or outpatient procedures to be requested over the phone, and they will only be accepted by submission via the portal or via fax.

 Note: Please ensure when requesting precertification for OP procedures (such as an appendectomy) please only request the code for the OP Procedure and do not include the code for observation.  When you have an OP surgery it includes recovery time, which allows the member to stay in the hospital and recover up to 24 hours if needed.

If you have questions about this communication or need assistance with any other item, contact your local Provider Experience representative or call Provider Services at 833-405-9086.

 

UnitedHealthcare May 2022 Network News

May 05, 2022

The May Network News from United Healthcare is now available for viewing.  You can access all of the applicable updates in detail by clicking on this link:  UHC May 2022 Provider News

  • Policy and Protocol Updates:  There are several updates for Commercial, Medicare and Medicaid
  • Medical Policy Updates:  Several updates for Commercial, Medicaid and Medicare.
  • Reimbursement Policy Updates:  Commercial only and it’s related to OP Hospital Maximum Frequency Per Day Policy
  • There are some Specialty Drug Updates and those can be viewed by following this link as well:  Specialty Drug Update

 

 

Cigna – New Reimbursement Policy: Unacceptable principal diagnosis codes

May 05, 2022

On August 13, 2022, Cigna will implement a new reimbursement policy, Unacceptable Principal Diagnosis Codes (R38), for claims billed with an unacceptable principal diagnosis code.  Unacceptable principal diagnosis is a coding convention in ICD-1O.  Those identified codes do not describe a current illness or injury, but a circumstance which influences a patient’s health status. These codes are considered to be unacceptable principal diagnosis codes.

Complete information regarding this policy can be found on the attached announcement.

Cigna – New Reimbursement Policy – Unacceptable Principal Diagnosis Codes 081322