Transcript TITLES SHOULD BE ALL UPPER CASE

Cigna Overview
Important information that will help guide our relationship
March 15, 2013
Stacy Coleman & Erica Thompson
Experience Consultants
TOPICS
I. Cigna benefit plans
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Cigna benefit plans
Strategic alliances
Shared Administrationsm
Cigna limited benefit medical plans
Cigna global health benefits
II. Electronic Solutions
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Cigna eServices - cignaforhcp.com & gwhcignaforhcp.com
Electronic data interchange (EDI)
Clear claim connection (CCC)
Cost of care estimator (COCE)
ERA, EFT & DDAR
III. Claim submission & Administrative Guidelines
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Claim submission
Appeals process
Precertification
National vendors
Demographic changes
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna
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Cigna Benefit Plans
CIGNA BENEFIT PLANS
Coverage and Requirements
Cigna offers several medical benefit plan designs. Each is listed below along
with its requirements.
• Preferred Provider Organization (PPO)
– No referrals required
– Some plans offer in-network coverage only
• Open Access
– Primary care physician (PCP) selection encouraged
– No referrals required
– Some plans offer out-of-network coverage
• Managed Care
– 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Confidential, unpublished property of Cigna.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
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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.
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna
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STRATEGIC ALLIANCES
Network Coverage for Multi-Site Clients
• Cigna’s strategic alliances include:
– Tufts Health Plan (CareLinkSM) 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
CareLinkSM 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.
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna
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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 management; precertification and medical necessity
review.
• 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.
• Cigna customers carry an ID card with a separate Cigna telephone number.
• Fundamental Care provides a higher level of coverage than Starbridge® and
the limited benefit plans provide an annual allowance.
• Check the covered patient’s ID card for correct contact information.
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna
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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.
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna
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Electronic Solutions
CIGNA eSERVICES
Enter your User ID and Password to log in to the Cigna for Health Care Professionals
website (CignaforHCP.com)
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna
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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:
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View patient eligibility and benefits
Estimate patient liability
View and submit precertification requests
View claim status
Access remittance reports
View claim coding edits
Email Cigna
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna
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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.
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna
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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
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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”.
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna
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CIGNA eSERVICES
Log in to the Secured
Provider Portal
(GWHCignaforHCP.com)
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
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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:
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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
Medical (including GWH-Cigna and Payer Solutions network), behavioral PPO,
dental, and Arizona Medicare Advantage HMO
SX071
Employee Assistance Program (EAP) and behavioral HMO
59225
Starbridge Beech Street claims
CLEAR CLAIM CONNECTION (CCC)
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Claim Coding Edit disclosure tool powered by McKesson, Inc.
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Accessible through CignaforHCP.com and GWHCignaforHCP.com.
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Users can enter CPT and HCPCS codes and immediately view audit results.
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Can review the rationale for disallowed codes.
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No PHI (Personal Health Information) exchanged.
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Professional claims only.
Features ®of(COCE)
the CIGNA Cost
COST OF CARE ESTIMATOR
of Care Estimator
• 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 (at scheduling) or while the patient is in the
office (before check-in or at checkout).
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)
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Electronic
Remittance
Advice (ERA)
ANSI 835
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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
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Electronic
Funds
Transfer
(EFT)
(Not currently
available for
payments
associated
with patients
with GWHCigna ID
cards)
EFT (or direct deposit) claim payments are deposited directly into your bank account,
avoiding mail delays.
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Payments are available the day of the deposit, increasing efficiency and improving cash
flow.
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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:
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For savings account deposits, you should verify that your bank supports EFT.
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If you use more than one tax ID number (TIN), you must complete a separate EFT
enrollment for each TIN .
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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
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To check the status of your EFT application, log in to CignaforHCP.com > Working with
Cigna, and view the Enrollment/Update Status.
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna
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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.
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna
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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 statespecific dispute policies, refer to the claim appeal information posted on our website.
Individuals with
Cigna ID cards
Cigna
National Appeals Unit
P.O. Box 188011
Chattanooga, TN 37422
Individuals with
GWH-Cigna ID cards
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
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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:
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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:
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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:
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Log in to the Secured Provider Portal (GWHCignaforHCP.com) > Precertifications
Call: 1.866.494.2111
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna
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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)
Quest Diagnostics, Inc. (Quest)
1.888.522.2677
1.866.MyQuest (697.8378)
for account set-up
for account set-up
labcorp.com
questdiagnostics.com
To find the nearest location:
 Call 1.888.522.2677
 Visit labcorp.com/psc
Make an appointment at the nearest location:
 Call 1.800.377.7220
 Visit questdiagnostics.com/appointment
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna
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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
Submission Options
Connecticut, Delaware, Illinois, Indiana,
Iowa, Maine, Massachusetts, Michigan,
Minnesota, New Hampshire, New Jersey,
New York, Ohio, Pennsylvania, Rhode
Island, Vermont, West Virginia, Wisconsin
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GWH phone: 1.888.663.8081
Cigna phone: 1.800.882.4462
Fax: 1.877.358.4301
Email: [email protected]
Alabama, Arkansas, Florida, Georgia,
Kentucky, Louisiana, Maryland,
Mississippi, North Carolina, Oklahoma,
Puerto Rico, South Carolina, Tennessee,
Texas, Virginia, Virgin Islands,
Washington DC
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GWH phone: 1.888.663.8081
Cigna phone: 1.800.882.4462
Fax: 1.888.208.7159
Email: [email protected]
Alaska, Arizona, California, Colorado,
Hawaii, Idaho, Kansas, Missouri, Montana,
Nebraska, Nevada, New Mexico, North
Dakota, Oregon, South Dakota, Utah,
Washington, Wyoming
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GWH phone: 1.888.663.8081
Cigna phone: 1.800.882.4462
Fax: 1.860.687.7336
Email: [email protected]
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna
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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.
THN-2012-431 © 2012 Cigna. Some content provided under license.