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: you can however, view your contract listing and rate information via the online rate matrix. A designated staff member at your organization should have login information to access this file. If you are contracted through a PHO, please contact your PHO representative if you have questions regarding your Mercy Managed Care Contracts.

Provider Changes

As a contracted provider, it is important to notifiy us immediately of changes 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.

Anthem Provider Newsletter – Missouri May, 2021

May 03, 2021

This  month’s featured articles…

 

Pharmacy:

  • Specialty pharmacy prior authorization update – Certain drugs for treatment of  ocular conditions continue to require prior authorization
  • Updates for specialty pharmacy are available – May 2021

Administrative:

  • Resources to support diverse patients and communities
  • Referring to network DME providers for negative pressure wound therapy helps members save on out-of-pocket costs
  • 2021 Affirmative statement regarding utilization management decisions
  • A helpful and complete guide to covered well-child visits
  • May is National High Blood Pressure Education Month
  • Digital online scheduling feature now available in the Availity Portal
  • Provider bulletins for medical and itemized bill attachments:  Electronic solutions at your fingertips
  • Sending larger digital attachments through Availity

Medical Policy & Clinical Guidelines:

  • New prior authorization requirement: Kidney transplantation
  • Update to AIM Specialty Health oncologic imaging clinical appropriateness guidelines
  • Updated AIM rehabilitative program effective August 1, 2021 – Initial evaluations and site of service reviews
  • Modification to voluntary Cancer Care Quality Program (CCQP) enhanced reimbursement to begin July 1, 2021

Reimbursement Policies:

  • Reimbursement policy update: Claims Requiring Additional Documentation – Facility
  • Reimbursement policy reminder: Readmission – Facility
  • Reimbursement policy update: Frequency editing – Professional

Medicare:

  • Keep up with Medicare news – May 2021
  • Maximizing efficient, high quality COVID-19 screenings

Anthem Provider Newsletter – Missouri May 2021

 

Cigna Network News 2nd Quarter 2021

April 29, 2021

This quarter’s featured articles…

 

FEATURE ARTICLE

  • Engaging with patients virtually

POLICY UPDATES

  • Preventive care services policy updates
  • Precertification updates
  • Clinical, reimbursement, and administrative policy updates

ELECTRONIC TOOLS

  • Online benefit viewing through procedure code lookup
  • Online appeals and claim reconsideration requests
  • Webinar schedule for digital solutions

NETWORK UPDATES

  • Cigna + Oscar plans expand in California and Georgia
  • LocalPlus plans expand in Midwest
  • Cigna Gene Therapy Program updates

QUALCARE NEWS

  • Claim submission PO boxes and payer IDs closed
  • Qual-Lynx workers’ compensation COVID-19 updates
  • Update contact information via email
  • PHARMACY NEWS
  • Changes in drug formulary effective January 1, 2021
  • National Preferred Formulary added as an option
  • Study: Greater Rx adherence in home delivery customers
  • Helping providers give new hope to patients with cancer
  • Accredo provider website improves prescribing capabilities

MEDICARE NEWS

  • Reminder: 2021 Cigna Medicare plan highlights

GENERAL NEWS

  • Claim denial prevention tips
  • Appeal reminders
  • intelliPath technology to help ease eviCore precertification process
  • Timely communication of test results
  • Providers must meet language assistance
  • compliance requirements
  • Home health services have transitioned to eviCore
  • Oncology advanced illness care
  • Cigna ambulatory medical record reviews
  • ASH management of acupuncture program: National expansion
  • Participate in the 2021 Leapfrog Hospital Survey
  • Updated LifeSOURCE provider reference guide now available

HELPFUL REMINDERS

  • Market Medical Executives contact information
  • Quick guides for Cigna and Medicare Advantage plans
  • Cigna Reference Guides
  • Use the network
  • Patient reviews reminders
  • Quick Guide to Cigna ID cards
  • Urgent care for nonemergencies
  • View drug benefit details using real-time benefit check
  • Transformations behavioral health digital newsletter
  • CareAllies education series
  • Resources to enhance interactions with culturally diverse patients
  • Have you moved recently? Did your phone number change?
  • Get digital access to important information
  • Access the archives
  • Letters to the editor

Cigna 2nd Quarter Network News April 2021

Home State Health – Updated Coding, Payment and Clinical Policies 060121

April 05, 2021

Home State Health has released the attached announcement regarding the following changes to their coding, payment and clinical policies effective June 1, 2021.

 

  • Drug Payment Reduction – Medicare
  • Outpatient Testing for Drugs of Abuse:  Presumptive Frequency Edits – Medicaid, Medicare and Marketplace
  • Correct Coding Update (Cotiviti 8, WCIVC B2) – Medicaid, Medicare and Marketplace

Home State – Updated Policies 060121

Cigna Coverage Policy Update – Continuous Glucose Monitors

April 05, 2021

Effective July 1, 2021, Cigna will change how they cover therapeutic continuous glucose monitors (CGMs) for patients who have both Cigna medical and pharmacy coverage.  For these patients, they will cover all components of therapeutic CGMs under the pharmacy benefit and may no longer cover therapeutic CGMs filled through a durable medical equipment or medical supply vendor under the medical benefit.

 

Additional information is included on the attached announcement.

Cigna – Coverage Policy Update – Continuous Glucose Monitor 070121

Cigna Coverage Policy Updates – Specialty Medical Drugs

April 05, 2021

Effective July 1, 2021, Cigna will make changes to the specialty medical drugs they cover to help ensure their customers have access to affordable and quality health care.  As a result, ELIGARD®, Fensolvi®, LUPRON DEPOT®, LUPRON DEPOT-PED®, and TRELSTAR® will require medical precertification and may be subject to site-of-care management.  They will also require medical precertification for FIRMAGON® and Zoladex®.

 

Additional information is included on the attached announcement.

Cigna – Coverage Policy Update – Specialty Drug Coverage 070121

Anthem Provider Newsletter – Missouri April, 2021

April 05, 2021

This  month’s featured articles…

Behavioral Health:

  • The health of millennials: Trends in behavioral health conditions

Pharmacy:

  • Correction: Updated formulary lists for commercial health plan pharmacy benefit effective April 1, 2021
  • Updates for specialty pharmacy are available – April 2021
  • Pharmacy information available at anthem.com

Administrative:

  • Important update to provider UM reimbursement penalties and corresponding entry in Provider Manual
  • The 2021 Provider Manual is now available
  • Does your practice offer telehealth services? Let us know!
  • Information Center – Access important policies, forms and helpful resources
  • Understanding Availity roles for electronic data interchange (EDI)
  • Make the change to digital authorization/referral and hospital admission notifications using EDI
  • Attention facilities: Sending admission, discharge and transfer data results in improved care management for patients
  • Chat directly with a prior authorization specialist
  • Keeping up with routine vaccination during COVID-19
  • Interactive bilingual website taking action for our health
  • Join Anthem in talking about racism and its impact on health

Medical Policy & Clinical Guidelines:

  • Medical policy and clinical guideline updates – April 2021
  • Update: Clinical guideline adoption postponed
  • MCG Care Guidelines 25th Edition available
  • Updated guidance on prior authorization requirements for admissions to in-network skilled nursing facilities (SNFs)
  • Maximizing efficient, high quality COVID-19 screenings
  • Update for Commercial providers: AIM sleep program CPT code E1399, NOC: Durable medical equipment, miscellaneous

Reimbursement Policies:

  • New reimbursement policy: Newborn Inpatient Stays for facilities

Federal Employee Plan (FEP):

  • HEDIS 2021 Federal Employee Program® medical record request requirements

Medicare:

  • Does your practice offer telehealth services? Let us know!
  • Oncology dose reduction program beginning July 1, 2021
  • Clinical criteria updates notification – November 2020
  • Clinical criteria updates notification – December 2020

Anthem Provider Newsletter – Missouri April 2021

Anthem Provider Newsletter – Missouri March, 2021

March 01, 2021

This  month’s featured articles…

 

Pharmacy:

  • Site of Care medical necessity reviews for long-acting colonystimulating factors begin June 1, 2021
  • Updates for specialty pharmacy are available – March 2021
  • Some HIV medication combinations may require prior authorization

Administrative:

  • Verifying and updating your provider information
  • Medical attachment capability now includes itemized bills and more!

Medical Policy & Clinical Guidelines:

  • Update: Notice of changes to the AIM Small Joint Surgery guideline

Reimbursement Policies:

  • Claims editing update for ICD-10-CM Excludes 1 notes

Medicare:

  • Medicare News – March 2021
  • New provider directory indicator for telehealth services
  • Medical policies and clinical utilization management guidelines update

Anthem Provider Newsletter – Missouri March 2021