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.

Cigna – Reimbursement policy update: Evaluation and management codes billed with modifier 25 and minor procedures

March 22, 2023

Cigna – Reimbursement Policy Update – E&M Codes Billed with Modifier 25 052523

  • Cigna will require the submission of office notes with claims submitted with evaluation and management (E&M) Current Procedural Terminology (CPT®) codes 99212, 99213, 99214, and 99215 and modifier 25 when a minor procedure is billed.
  • The E&M line will be denied if they do not receive documentation that supports that a significant and separately identifiable service was performed.
  • This update is effective for dates of service on or after May 25, 2023.


Evernorth (Cigna Behavioral Health) EAP Reminder

March 16, 2023

Evernorth EAP Reminder:

Arkansas BCBS – Providers News March 2023

March 16, 2023

Arkansas BCBS – Providers News March 2023

This month’s featured articles:

Arkansas Blue Cross and Blue Shield

  • Name Change Announcement: AIM Specialty Health will transition to Carelon Medical Benefits Management Inc
  • New Directions and Tridiuum become Lucet
  • Routing of Secondary Claims
  • Prescription Drug Benefits Reminder
  • PA Process Changes Delayed Until August
  • Public Health Emergency (PHE) Ending
  • Timely filing. National Emergency
  • Medical specialty medications prior approval update
  • Coverage policy manual updates
  • Standard Formulary changes effective April 1, 2023
  • Metallic Formulary changes effective May 1, 2023

Federal Employee Program (FEP)

  • Cervical Cancer Screening – How to improve your scores and close the gaps
  • FEP Health Focus of the Month: Prenatal and Postpartum Care

Medicare Advantage

  • Arkansas Blue Medicare 2023 Plans
  • AR Blue Medicare Value Based Care program recognition
  • Centers for Medicare and Medicaid Services (CMS) preclusion list
  • Reminder on billing qualified Medicare beneficiaries
  • Requirements for outpatient observation care

Healthy Blue Medicaid March 2023 Provider News

March 09, 2023

The March 2023 Healthy Blue Medicaid Providers News is available for review by following the link below.

Read the Newsletter

This issue features the following articles:


  • Remittance advice message enhancements

Digital Tools:

  • Introducing the Provider Learning Hub
  • Advancing Mental Health Equity for Youth and Young Adults

Policy Updates:

  • Medical Policies, Clinical Guidelines and Reimbursement Policies
    • Carlon Medical Benefits Management
    • Modifiers 25 and 57

Quality Management:

  • Reminder to prepare for HEDIS medical record review

United Healthcare Monthly Overview – March 2023

March 09, 2023

Please follow the link below to view updated policies and guidelines from United Healthcare.

March monthly overview | UHCprovider.com

Anthem Provider Newsletter – March, 2023

March 06, 2023

Anthem Provider Newsletter – Missouri March 2023

This month’s featured articles:


  • Reminder – Updated Carelon Musculoskeletal Program effective April 1, 2023: monitored anesthesia care reviews
  • Statin Therapy Exclusions for Patients With Cardiovascular Disease/Diabetes HEDIS measures
  • Carelon Medical Benefits Management (formerly AIM Specialty Health) Radiology Clinical Appropriateness Guidelines CPT code list update
  • Reminder: Updated Carelon Medical Benefits Management, Inc. Musculoskeletal Program effective April 1, 2023 – Site of care reviews
  • New policy for EMR clinical data sharing and ADT notifications
  • You are invited: Advancing Mental Health Equity for Youth & Young Adults
  • March is National Colorectal Cancer Awareness Month
  • Provider directory – annual audit for NCQA Accreditation
  • Time to prepare for HEDIS medical record review

Reimbursement Policies:

  • Reimbursement policy update: Modifiers 25 and 57 – Professional

Products & Programs:

  • Consumer payment option, Pay Doctor Bill, to terminate effective March 31, 2023


  • Pharmacy information available on our provider website
  • Specialty pharmacy updates for March 2023


  • Controlling High Blood Pressure and Submitting Compliant Readings
  • Informational Update Modifier Usage
  • Shared savings and transition care management after inpatient discharges
  • Annual planned visits
  • Keep up with Medicare News – March 2023

Medica March 2023 Connections

March 03, 2023

The March edition of the Medica Connections news letter is now available for review.  Please access the link below for information on upcoming policy and clinical guideline changes as well as updates to pharmacy policies.  Also included is information regarding registration for the monthly training sessions.

Mar2023Conn – Final

UHC Individual & Family Exchange Plan Virtual Lunch and Learn

February 17, 2023

We received notice from UHC regarding Virtual sessions they are hosting for our Mercy hospitals, physicians and ancillary providers to review their Individual Exchange product.  This should provide quite a bit of information and will hopefully answer any questions you might have.  Please feel free to forward this to any of your staff that might benefit.


Is Your Team Familiar with our Exchange Plans?

We would like to help.  Please join us to learn more about the UHC Individual & Family Exchange Plans. We will identify plan types, explore plan features, work with the plan, and more.

 Individual & Family Exchange Plan Virtual Lunch and Learn Sessions 

Register Today By Clicking on the Date/Time Options Below (Feel free to forward within your team as well.)  Registration IS required to attend:

Wednesday, February 22, 2023, 12:00pm – 1:00pm CST

Thursday, February 23, 2023, 11:00am – 12:00pm CST

Visit UHCprovider.com/exchanges to access:

  • The 2023 Individual Exchange plans self-paced interactive guide
  • Our policies, coverage determination guidelines and prior authorization requirements
  • State-specific prescription drug lists (PDLs)
  • Individual Exchange plan news