1. LAKELAND CARE PAYER CONFERENCE OCTOBER 18, 2017

2. 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 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
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3. 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 Cigna ( )
For patients with GWH-Cigna or “G” ID cards:
Call
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Confidential, unpublished property of Cigna.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

4. 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 , Chattanooga, TN
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

5. 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

6. 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

7. 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 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

8. 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

9. 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
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10. SAMPLE ID CARD
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2017 Cigna

11. 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:
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

12. resources for you CignaforHCP.com
Cigna Customer Service: (800)
Network News
To be added to the distribution list for the Network News
Thank you!
Lauren Koons
(860)
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2017 Cigna