1. CIGNA Funds Overview  Category A Settlement Fund* (No Documentation): $30 million OR/  Claim Distribution Fund* (No Limitation/Cap) Category 1 Compensation: Specific Code List Category 2 Compensation: Other Codes Medical Necessity Claims Compensation  Foundation Fund: $15 million * Physician may contribute to Foundation Fund

2. Additional Information on CIGNA Claims Submission Timeframe: 180 Days from Notification Covers HMO, PPO and Indemnity Patients Physician Groups/Organizations May File for Physicians Working for them at the time claims were made, without signatures. Must be same provider ID number. Physicians may file for Category A regardless of whether they submitted claims to CIGNA HealthCare

3. Additional Information on CIGNA Claims Submission: Timeframe September 2, 2003: Preliminary Approval Hearing & Order December 18, 2003: Fairness Hearing October 2003: First Settlement Notice Mailed February 12, 2004: Appeals Filed April 22, 2004: Appeals Dismissed Week of May 3, 2004: Extensions to be Filed to Resolve Several Issues (Electronic Filings, etc.) June 15, 2004 (Estimated) Second Settlement Notice Mailed June 15-December 15, 2004: 180 Days to Submit Claims to Settlement Administrator

4. Additional Information on CIGNA Claims Submission: Category A –Formula No. of Retired Physicians, plus No. of Deceased Physicians (Times Two); Plus No. of Active Physicians Sending in Category A Form= No. Physicians No. Physicians Divided by$30,000,000 = Result Result = Amount Paid Per Physician –Comment: The Amount Per Physician will vary significantly depending on number of physicians applying for Category A Funds (Estimated Range: $50-$400)

5. Additional Information on CIGNA Claims Submission: Category One CPT Codes and Code Sets Underpaid, Bundled or Downcoded Specified Time Periods from 1/1/96-12/31/03 Paid at Amounts Specified on Category One List Specific Documentation and Certification Requirements Found in Draft Notice Category One Code List: Exhibit 1 of the CIGNA Settlement Agreement

6. Additional Information on CIGNA Claims Submission: Category Two All Other CPT Codes Improperly Denied, Reduced Also Includes Code Sets Outside of the Specified Time Periods in Category 1 Failure to recognize Modifiers 50, 51, RT, LT, FA-F9 and TA-T9 HCPCS Level II “J” codes translated into an incorrect or overbroad CPT Code

7. Additional Information on CIGNA Claims Submission: Category Two Paid at 100% of June 1, 2001 Medicare Rates Request/Obtain Your Facilitation List from Settlement Administrator Specific Documentation and Certification Requirements Found in Draft Notice May require: HCFA 1500, EOB & Medical Records

8. Additional Information on CIGNA Claims Submission: Category Two Claims Submission –Cover Sheet –Certification –Documentation Notified of Inadequate Documentation within 14 Days: 30 Days to Resubmit External Review of Re-Denials

9. Additional Information on CIGNA Claims Submission: Medical Necessity Resubmit if Improperly Denied Based On: –Medically Necessity –Experimental or Investigational Does not include Coverage Determinations If Re-Denied, CIGNA Must Submit to External Reviewer

10. CIGNA Claims Submission Read Claim Notice Form Carefully Outstanding Issues: –Electronic vs. Manual Submission –Documentation Requirements: Facilitation List –Vendors: Certification Find Settlement Agreement and All Forms: http://www.hmosettlements.com

11. North Carolina Managed Care Patient Assistance Program  Created by NC Patient’s Bill of Rights (2001)  Located in Attorney General Roy Cooper’s Office  Patient Assistance Specialists “provide advice to consumers, caregivers, and providers about insurance and managed care issues including benefits, grievances, appeals, and external review processes.”  (919) 733-MCPA (6272) or toll free (866) 867- MCPA (6272) or via email @ MCPA@mail.jus.state.nc.us.