LAKELAND CARE PAYER CONFERENCE OCTOBER 18, 2017

Information. Delivered. CignaforHCP.com and our trading partners Trading Partners/EDI Vendors Delivery of information through CignaforHCP.com Patient Information and Transactions Eligibility and benefits Patient out-of-pocket cost estimation (medical, behavioral) Precertification submission and inquiry (medical) Claims status inquiry Electronic funds transfer enrollment and management Remittance reports Resources eCourses Cigna formularies/drug list ID cards Clinical reimbursement and payment policies Forms Reference guides Delivery of information through HIPAA 5010 transactions Eligibility and benefits inquiry and response (270/271) Health service review/precertification (278) Electronic claim submission (837) Claim acknowledgement (277CA) Claims status inquiry and response (276/277) Electronic remittance advice (835) Patient out of pocket cost estimation (Availity only) Electronic funds transfer enrollment and management (CAQH only) Transaction availability varies by partner/vendor. For more information, visit Cigna.com/EDIvendors. For more information on EDI, click here: CignaforHCP.Cigna.com/public/content/pdf/resourceLibrary/eCourses/medical/ediOptions/EDI_eligibility.pdf Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2015 Cigna

Precertification Check the back of the patient’s ID card or CignaforHCP.com > Resources > Clinical Reimbursement Policies and Payment Policies > Precertification Policies for coverage and precertification requirements. The website will have the most up-to-date information. Submit requests for elective procedures at least 72 hours before the scheduled service. For patients with Cigna ID cards: Log in to CignaforHCP.com > Patients > View & Submit Precertifications, or Call 800.88Cigna (882.4462) For patients with GWH-Cigna or “G” ID cards: Call 866.494.2111 All changes and updates to precertification can be viewed by logging in to CignaforHCP.com > Resources > Clinical Reimbursement Policies and Payment Policies > Precertification Policies The referring physician is responsible for obtaining approval for all services that require precertification prior to services being rendered. Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2017 Cigna

How to submit claims to Cigna You can submit your claims to Cigna electronically, including coordination of benefits (COB) and corrected claims. Use Cigna Payer ID 62308 Cigna primary claims must be submitted within 180 days of the date of service. Secondary claims must be submitted within 180 days of the receipt of the primary payers EOB Cigna accepts paper claims, however, we strongly encourage you to submit claims electronically. Claim Mailing Address: PO Box 188061, Chattanooga, TN 37422-8061 For more information on how to submit claims to Cigna visit Cigna.com > Resources for Health Care Professionals > Doing Business with Cigna > How to Submit Claims to Cigna Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2017 Cigna

APPEAL PROCESS Cigna strives to informally resolve issues raised by providers on initial contact whenever possible. If issues cannot be resolved informally: Cigna offers a single-level, internal appeal process to resolve contractual disputes regarding post-service payment denials and payment disputes. Processes may vary due to state mandates or contract provisions. The appeal must be initiated within 180 calendar days of the date of the initial payment or denial decision. Arbitration may be used as a final resolution step after the internal Cigna process is complete. Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2017 Cigna

Understand the denial before you file an appeal. FILING AN APPEAL Understand the denial before you file an appeal. Most claim issues can be remedied quickly by providing requested information to a claim service center, contacting us, or resubmitting the claim. Carefully review the message(s) on your EOP to determine the reason for a denial of services or a payment reduction. We recommend contacting Cigna Customer Service before filing an appeal for: Claim errors Contract and fee disputes Out-of-network claim payment disputes For additional information on how to submit an appeal, please review the Claim Adjustment & Appeals Guidelines on CignaforHCP.com > Resources > Clinical Reimbursement Policies and Payment Policies > Claims Appeals Policies and Procedures > Appeal Policy and Procedures. Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2017 Cigna

FILING AN APPEAL (CONT.) Submit the right information when you file an appeal. Always attach the appropriate documents to support the coverage request and the patient’s condition: Authorization of coverage or medical necessity – attach clinical documents, medical records, etc. Inpatient facility denial (level of care or days) – attach a complete facility record. Failure to obtain precertification – if urgent, emergent, or extenuating circumstances prevented you from obtaining precertification, include this information along with supporting clinical documentation. Untimely claim submission – include proof of timely filing. Claim bundling edits and modifiers - review claim bundling edit information using the Clear Claim Connection tool, and the modifier reimbursement information both located at www.CignaforHCP.com. Submit supporting documentation if you disagree with this information. To ensure efficient routing and handling of an appeal, complete the Request for Health Care Professional Payment Review form located on the Cigna for Health Care Professionals website (CignaforHCP.com > Resources > Form Center > Medical Forms). Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2017 Cigna

A new, easy way to view sample Cigna ID cards The Quick Guide to Cigna ID cards interactive digital tool View sample ID cards for certain plan types Choose the image that matches the patient’s ID card See both the front and the back of the card Choose “About This Plan” to read more about the plan To access the Quick Guide to Cigna ID Cards digital tool, go to Cigna.com > Health Care Professionals > ID Card Details or go to CignaforHCP.com > View Sample ID Cards Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2017 Cigna

USING THE DIGITAL ID CARD TOOL Key features Interactive, easy-to-navigate tool on Cigna.com Quick online access to patient ID card samples, plan details and requirements, direct links to the provider directory, Provider Digital Solutions options, myCigna mobile app overview, important contacts, and more. View demo View tool Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2017 Cigna 9

SAMPLE ID CARD Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2017 Cigna

Sample explanation of payment We provide an explanation of payment (EOP) for all claims submitted. We strongly encourage you to enroll in electronic funds transfer (EFT) and electronic remittance advice (ERA). When used together, you can get paid faster and shorten your payment cycle. There are two options to enroll in EFT: Enroll in EFT with multiple payers, including Cigna, using the Council for Affordable Quality Health Care website: https://solutions.CAQH.org. Enroll in EFT directly with Cigna by logging in to CignaforHCP.com > Working with Cigna > Enroll in Electronic Funds Transfer (EFT) Options. To enroll in ERA with Cigna, contact your EDI vendor. Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2017 Cigna

resources for you CignaforHCP.com Cigna Customer Service: (800) 882-4462 Network News To be added to the distribution list for the Network News email NetworkNewsEditor@Cigna.com Thank you! Lauren Koons (860) 787-6847 lauren.koons@cigna.com Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2017 Cigna