TITLES SHOULD BE ALL UPPER CASE

– PCP selection required – – Referrals required Some plans offer out-of-network coverage Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna 4

CIGNA BENEFIT PLANS

Cigna Choice Fund ® Plans

• A health care fund can be packaged with an underlying PPO or Open Access Plus medical plan.

• Two funding options are available: – – Health Reimbursement Account (HRA) Health Savings Account (HSA) • Preventive care is generally paid at 100%.

• No copayments apply.

• If funds are available, you may receive coinsurance and deductible payments from a patient’s HRA or HSA account through the automatic claim forwarding function.

STRATEGIC ALLIANCES

Network Coverage for Multi-Site Clients

• C

igna’s

strategic alliances include: – Tufts Health Plan (CareLink SM ) in Massachusetts and Rhode Island – – – Health Alliance Plan (HAP) in Michigan HealthPartners in Minnesota, Western Wisconsin and North Dakota MVP/Preferred Care in upstate New York • Covered individuals in these areas access the alliance’s network of health care professionals. Note: In Massachusetts and Rhode Island, some individuals may access Cigna’s network while others access the Tufts CareLink SM network of health care professionals.

• Outside these areas, individuals can use

Cigna’s network of health care professionals, and Cigna contracted rates apply.

• A covered individual’s ID card will display the

Cigna name for easy identification.

• Check the covered patient’s ID card for the correct contact information.

SHARED ADMINISTRATION

Taft-Hartley and Federal Employee Benefit Plans

•

Cigna contracts with Taft-Hartley trusts and federal employee health benefit plans to share administration of these self-funded plans.

•

Participating individuals have access to Cigna’s network, and Cigna contracted rates apply.

•

Cigna performs medical

review.

management; precertification and medical necessity • A third party administrator (TPA) maintains eligibility, administers benefits and pays claims for these accounts on their systems.

• Check the covered individual’s ID card for correct contact information.

CIGNA LIMITED BENEFIT PLANS

Starbridge ® and Fundamental Care

• Starbridge

and Fundamental Care provide medical coverage for basic health care services to part-time, hourly or other employees who do not have access to traditional coverage.

• C

igna

customers carry an ID card with a separate

Cigna telephone number.

• Fundamental Care provides a higher level of coverage than Starbridge

the limited benefit plans provide an annual allowance.

and • Check the covered patient’s ID card for correct contact information.

CIGNA GLOBAL HEALTH BENEFITS

•

Cigna Global Health Benefits provide coverage for:

–

Expatriate employees and dependents living outside the U.S. when they return to the U.S. for care

– –

Foreign nationals and dependents working in the U.S.

American employees living outside the country, working for defense contractors with dependents living in the U.S.

• Authorizations are required for inpatient admissions.

• Check the covered patient’s ID card for correct contact information.

Electronic Solutions

CIGNA eSERVICES

Enter your User ID and Password to log in to the Cigna for Health Care Professionals website ( CignaforHCP.com

CIGNA eSERVICES

• • • Log in CignaforHCP.com

to: Easily access all your tools from your new Dashboard Flag patients and claims to quickly and easily save information to your dashboard Save your work automatically so it’s available the next time you log in Here are some of the functions you can use in the website: • • • • • • • View patient eligibility and benefits Estimate patient liability View and submit precertification requests View Access remittance reports View claim coding edits Email claim status Cigna Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna 12

CIGNA eSERVICES

• • • • • • • Under Resources, you can: Access the Cigna reference guides View claim appeals policy View claim submission addresses and requirements Review disease management programs Access electronic prescription submission View pharmacy formulary View the provider directory

Remember to check the site often for policy and Procedure updates.

CIGNA eSERVICES

Learn more about Cigna eServices by accessing our online training material. Log in to ( CignaforHCP.com

)>eCourses.

• • • • Online training content is: Available free to registered users Requires no special software Can be accessed 24x7 Can be downloaded or printed to review offline Examples of available material: Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna 14

CIGNA eSERVICES

• Enter your User ID and password to log in to the Secured Provider Portal ( GWHCignaforHCP.com

) • If you are not already registered to use the website, click “Register Now”.

CIGNA eSERVICES

) to: • View important updates to plans and services • Check the details of processed claims • View precertification requirements • Access helpful resources, including: – Clinical guidelines – – – Payment guidelines Dispute resolution Reference Guides Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna 16

ELECTRONIC DATA INTERCHANGE (EDI)

You have two options for exchanging EDI transactions with Cigna – by directly connecting to the Cigna systems using free software from Post-N-Track or by using a clearinghouse.

• Post-N-Track™ is a web-based service that allows you to submit claims directly to Cigna: – Claims are immediately delivered to Cigna; eliminates clearinghouse problems – Built-in claim tracking reports – For enrollment and additional information, visit www.post-n-track.com

– installation takes less than 5 minutes • Clearinghouses – Clearinghouse services allow you to: – Submit claims to Cigna – Receive Electronic Remittance Advice (ERA) statements – Exchange Electronic Claim Status Inquiry and Response transactions (276/277) – Exchange Electronic Eligibility and Benefit Inquiry and Response transactions (270/271) – Submit Electronic Pre-certification and Authorization requests (278) • Payer IDs to use when submitting electronic claims to Cigna:

Payer ID Claim Type

62308 SX071 Medical (including GWH-Cigna and Payer Solutions network), behavioral PPO, dental, and Arizona Medicare Advantage HMO Employee Assistance Program (EAP) and behavioral HMO 59225 Starbridge Beech Street claims

CLEAR CLAIM CONNECTION (CCC)

• Claim Coding Edit disclosure tool powered by McKesson, Inc.

• Accessible through CignaforHCP.com

and GWHCignaforHCP.com

. • Users can enter CPT and HCPCS codes and immediately view audit results. • Can review the rationale for disallowed codes.

• No PHI (Personal Health Information) exchanged.

• Professional claims only.

• Can be used in

all care settings

(professional services in all locations, outpatient and inpatient facilities).

• Only

available for health care professionals who participate in the Cigna network.

• Available for

patients in Cigna HMO/Network medical plans, Cigna PPO, EPO and Open Access Plus (OAP/OAPIN) benefit plans

, including individuals with Cigna Choice Fund.

• Estimates includes anticipated payment from individual’s FSA/HRA/HSA account when Automatic Claim Forwarding is enabled.

• Estimated costs are

specific to the health care professional or facility requesting the estimate, the treatment or service, and the covered individual’s benefits at the time the estimate is generated.

• Estimates

can be generated pre-care office

(before check-in or at checkout).

(at scheduling) or

while the patient is in the

CIGNA eSERVICES

Explanation of Estimate

Click

Print Explanation of Estimate

to print a copy for your patient.

After you submit the estimate, you will see this

Explanation of Estimate

CIGNA eSERVICES

Electronic Remittance (ERA) and Electronic Funds Transfer (EFT) Electronic Remittance Advice (ERA) ANSI 835 Electronic Funds Transfer (EFT)

(Not currently available for payments associated with patients with GWH Cigna ID cards)

• • • ERA, or the ANSI 835, is the HIPAA-compliant detailed explanation of how your claim was processed.

ERA is available for patients with Cigna or GHW-Cigna ID cards.

The ERA may be automatically loaded into your account receivable system, which can: – – – – Help reduce costs Save time Reduce posting errors Shorten the payment cycle • • EFT (or direct deposit) claim payments are deposited directly into your bank account, avoiding mail delays.

Payments are available the day of the deposit, increasing efficiency and improving cash flow.

• A separate Direct Deposit Activity Report (DDAR) or Remittance Report is made available for each deposit on the Cigna for Health Care Professionals website ( CignaforHCP.com

). The Remittance Report provides details of the claims processing payments included in the fund transfer.

• • • • Important information about EFT: For savings account deposits, you should verify that your bank supports EFT.

If you use more than one tax ID number (TIN), you must complete a separate EFT enrollment for each TIN .

If your TIN, billing address or bank account changes, you must submit a change request by logging into ( CignaforHCP.com

) > Working with Cigna > Manage EFT Settings To check the status of your EFT application, log in to Cigna, and view the Enrollment/Update Status.

CignaforHCP.com

DIRECT DEPOSIT ACTIVITY REPORT (DDAR)

• Immediate online access to your remittance reports (DDAR) and checkless EOP the same day you receive your electronic funds transfer.

• A single tracking number on your DDAR, ERA and EFT helps make reconciling payments easier.

• To access report, log-in to CignaforHCP.com

. Under “Remittance Reports” choose how you want to search for your report.

• If you are enrolled for Electronic Remittance Advice (ERA)/ANSI 835, you will still receive your ERA through your EDI vendor.

• Not available for patients with GWH-Cigna ID Cards at this time.

Claims Submission & Administrative Guidelines

CLAIM SUBMISSION

Improving Processing and Payment Accuracy

• Electronic claim submission can improve claim accuracy.

• If Cigna is the: – Primary payer, then claims must be submitted within 90 days of the date of service – Secondary payer, then the claim must be submitted within 90 days of the date of receipt of the Explanation of Benefits (EOB) from the primary payer • To help ensure timely and accurate payments, include the following complete and correct information on each claim submission: – – – Contracted Tax Identification Number (TIN) Health care professional’s name as reported to Cigna TIN owner’s name, billing address, and telephone number as reported to the Internal Revenue Service • Cigna accepts National Provider Identifiers (NPIs) on standard HIPAA transactions, but the federal TIN must also be included for tax reporting purposes. • Cigna accepts CMS-1500 forms for professional claims and UB-04 forms for institutional claims; Cigna also accepts older versions of these claim forms.

SUBMIT CORRECTED CLAIMS ELECTRONICALLY

• Did you know that you can also submit corrected claims electronically? To submit your corrected claim, make the necessary corrections, update the Claim Frequency Code and submit. It’s that easy!

• For corrected claims, the Claim Frequency Type Code in Loop 2300, Segment CLM05 should specify the frequency of the claim (this is the third position of the Uniform Billing Claim Form Bill Type) using one of the following codes: – 1 – Original (admit through discharge claim) – 7 – Replacement (replacement of prior claim) – 8 – Void (void/cancel of prior claim) • This applies to Cigna and GWH-Cigna

APPEALS PROCESS

To Resolve Payment Disputes

Cigna offers two levels of appeal for participating health care professionals.

• First appeal must be sent within 180 calendar days of the date of initial payment or denial.

• Second appeal must be sent within 60 calendar days of the date of the first appeal decision letter.

• For more information about appeals refer to the Health Care Professional Reference Guide available on both CignaforHCP.com

and GWHCignaforHCP.com

. Note: Appeals policies may vary by state; statute supersedes Cigna policy. For details on state specific dispute policies, refer to the claim appeal information posted on our website.

Individuals with Cigna ID cards Individuals with GWH-Cigna ID cards

Cigna National Appeals Unit P.O. Box 188011 Chattanooga, TN 37422 Cigna GWH-Cigna National Appeals P.O. Box 668 Kennett, MO 63857 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna 26

PRECERTIFICATION

• The referring physician is responsible for obtaining approval for all that require precertification

prior

to services being rendered.

• Check the back of the patient’s ID card or our secure websites for coverage and precertification requirements; the websites will have the most up-to-date information.

• Submit requests for elective procedures at least 72 hours before the scheduled service.

• On-line precertification: – – Get an immediate response to your precertification request – some may get immediate approval Receive a tracking number on every request – – Print responses for your patient records View the status of any precertification request – including those submitted by phone or by fax.

• For Cigna ID Cards, use the following channels: – – – Log in website ( CignaforHCP.com

) > View and Submit Precertification Requests Call: 1.800.88Cigna (882.4462) https://navinet.navimedix.com

• For GWH-Cigna ID Cards, use the following channels: – – Log in to the Secured Provider Portal ( GWHCignaforHCP.com

) > Precertifications Call: 1.866.494.2111

NATIONAL VENDORS

Laboratory Referrals

For laboratory referrals, select from either one of the nation’s largest preferred laboratories listed below, or refer to the health care professional online directory for a list of other available in-network laboratories. • For patients with Cigna ID cards, access the directory at CignaforHCP.com

• For patients with GWH-Cigna ID cards access the directory at GWHCignaforHCP.com

Call Website Patient Service Centers Laboratory Corporation of America (LabCorp)

1.888.522.2677

for account set-up labcorp.com

To find the nearest location:  Call 1.888.522.2677

 Visit labcorp.com/psc

Quest Diagnostics, Inc. (Quest)

1.866.MyQuest (697.8378)

for account set-up questdiagnostics.com

Make an appointment at the nearest location:  Call 1.800.377.7220

NATIONAL VENDORS

Home Health Care - CareCentrix

– CareCentrix is the national provider of home health care, home infusion and durable medical equipment. For a complete list of services and CPT codes covered by CareCentrix, log in to CignaforHCP.com

> Resources > Clinical Reimbursement Policies and Payment Policies > CareCentrix DME HCPCS Codes .

– Call CareCentrix at 1.800.666.6127 to complete an order for these services (precertification may be required).

Orthotics/Prosthetics Linkia

– For Orthotic and/or Prosthetic devices contact Linkia at 1.877.754.6542

MedSolutions (MSI)

– To precertify high-tech imaging services (MRI, CT , PET, Nuclear Cardiology Imaging), contact MSI at 1.888.693.3297 or www.cigna.medsolutionsonline.com

– [email protected]

or 1.800.575.4517 option #2.

DEMOGRAPHIC CHANGES

Please notify us in writing 90 days before changing your office or billing address, telephone number, tax identification number or specialty. Submit your demographic changes to:

State

Connecticut, Delaware, Illinois, Indiana, Iowa, Maine, Massachusetts, Michigan, Minnesota, New Hampshire, New Jersey, New York, Ohio, Pennsylvania, Rhode Island, Vermont, West Virginia, Wisconsin Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, Virginia, Virgin Islands, Washington DC Alaska, Arizona, California, Colorado, Hawaii, Idaho, Kansas, Missouri, Montana, Nebraska, Nevada, New Mexico, North Dakota, Oregon, South Dakota, Utah, Washington, Wyoming Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna

Submission Options

• GWH phone: 1.888.663.8081

• Cigna phone: 1.800.882.4462 • Fax: 1.877.358.4301

• Email: [email protected]

• GWH phone: 1.888.663.8081

• Cigna phone: 1.800.882.4462 • Fax: 1.888.208.7159

• Email: [email protected]

• GWH phone: 1.888.663.8081

• Cigna phone: 1.800.882.4462 • Fax: 1.860.687.7336

• Email: [email protected]

REMINDERS

• Reference Guides containing our administrative guidelines for physicians, hospitals, and ancillary facilities are continually updated and posted on the HCP website. − − CignaforHCPcom > Resources > Reference Guides.

GWHCignaforHCP.com

>Tools & Resources > Healthcare professional Reference Guide.

• Cigna Tel-Drug Specialty Pharmacy is available for medications administered in the office. Tel-Drug will work directly with Cigna to facilitate the precertification process on your behalf, and will bill Cigna directly for dispensed medications. Visit Cigna.com

or call Cigna Tel-Drug Specialty Pharmacy at 1.800.351.3606 for more information.

• Network News, our network newsletter, is available quarterly via email or hard copy and online at CignaforHCP.com

"Cigna" is a registered service mark and the "Tree of Life" logo and “GO YOU” are service marks of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its operating subsidiaries. All products and services are provided by such operating subsidiaries and not by Cigna Corporation. Such operating subsidiaries include Connecticut General Life Insurance Company, Cigna Health and Life Insurance Company, and HMO or service company subsidiaries of Cigna Health Corporation and Cigna Dental Health, Inc. All models are used for illustrative purposes only.

TITLES SHOULD BE ALL UPPER CASE

Transcript TITLES SHOULD BE ALL UPPER CASE

Cigna Overview

Important information that will help guide our relationship

TOPICS

I. Cigna benefit plans

II. Electronic Solutions

III. Claim submission & Administrative Guidelines

Cigna Benefit Plans

CIGNA BENEFIT PLANS

Cigna offers several medical benefit plan designs. Each is listed below along with its requirements.

Primary care physician

CIGNA BENEFIT PLANS

STRATEGIC ALLIANCES

igna’s

Cigna’s network of health care professionals, and Cigna contracted rates apply.

Cigna name for easy identification.

SHARED ADMINISTRATION

Cigna contracts with Taft-Hartley trusts and federal employee health benefit plans to share administration of these self-funded plans.

Participating individuals have access to Cigna’s network, and Cigna contracted rates apply.

Cigna performs medical

CIGNA LIMITED BENEFIT PLANS

igna

Cigna telephone number.

CIGNA GLOBAL HEALTH BENEFITS

Cigna Global Health Benefits provide coverage for:

Expatriate employees and dependents living outside the U.S. when they return to the U.S. for care

Foreign nationals and dependents working in the U.S.

American employees living outside the country, working for defense contractors with dependents living in the U.S.

Electronic Solutions

CIGNA eSERVICES

CIGNA eSERVICES

CIGNA eSERVICES

CIGNA eSERVICES

CIGNA eSERVICES

CIGNA eSERVICES

ELECTRONIC DATA INTERCHANGE (EDI)

CLEAR CLAIM CONNECTION (CCC)

CIGNA eSERVICES

CIGNA eSERVICES

DIRECT DEPOSIT ACTIVITY REPORT (DDAR)

Claims Submission & Administrative Guidelines

CLAIM SUBMISSION

SUBMIT CORRECTED CLAIMS ELECTRONICALLY

APPEALS PROCESS

PRECERTIFICATION

NATIONAL VENDORS

Call Website Patient Service Centers Laboratory Corporation of America (LabCorp)

1.888.522.2677

Quest Diagnostics, Inc. (Quest)

1.866.MyQuest (697.8378)

NATIONAL VENDORS

DEMOGRAPHIC CHANGES

REMINDERS

Directory