providers according to plan rules as listed in the online provider manual. After one year and prior to four years from the date of determination, "good cause" is required for Medicare to reopen the claim. ka[|Ku@,OK"5HwC8UR10w%oF~O>?q8P y|Qge?6N$i@5@)Q \hRC-$J2RpjnPpS=ud7ofT& *FQQe^ afsTOln7ePX5@bGpF]$J\[R^5s=>nfL4f]_I>-!R|79@[Z6PVpd1*%FW0TCBGWP4|! You may request precertification through eviCore in the following ways: For additional information, refer to eviCores provider resources website (www.eviCore.com/resources/healthplan/Cigna). Helping you keep up with research, trends, and policy changes that impact your practice. 128 0 obj <>stream endstream endobj startxref Please click here to register for an account. Remember: Your contract with Cigna prohibits balance billing your patient if claims are denied because they were not submitted within the time frame outlined above. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna. To submit a Prior Authorization request:Visit the Provider Portal at HSConnectOnline.com. hb``b``Ab,nF )H\g```h i~ a,g}]Ig]7 1fq61` v T ob!!|Fy JC Please call QualCare Provider Relations at 800.992.6613 if you have any questions or concerns. These include: If you are not currently registered for the Cigna for Health Care Providers website, go to CignaforHCP.com and click on the Login/Register link. Browse Medical Resources Medical Reference Guides Here you'll find reference guides to help make it easier for health care professionals to do business with Cigna. In Network Providers - Set up ACH/EFT Payments, Out of Network Providers - ACH/ERA Enrollment, Out of Network Providers - Claims Disputes, Optum Behavioral Health Toolkit for Providers, Behavioral Health HEDIS Measures Summary for Primary Care, Important information about Coordinating Care, Care for Individuals Diagnosed with Schizophrenia, Metabolic Screening for Children and Adolescents on Antipsychotics, Opioid Use Disorder Quick Reference Guide. This website is not intended for residents of New Mexico. cigna commercial provider manual 2021; How to Easily Edit Cigna Billing Manual Form Online. Keeping Dental Health providers up to date. As part of our continued effort to provide a high quality user experience while also ensuring the integrity of the information of those that we service is protected, Clinical decisions, including treatment decisions, are the responsibility of the individual and his/her provider. Optum Womens and Childrens Health, LLC: Healthy Connections Home Care Services, Inc.: Compression therapy products for lymphatic and venous disorders, DME, including off the shelf and drop ship to home (i.e., braces, splints, slings, canes, walkers, prefabricated O&P, and knee supports). eviCore positions. Read our quick-reference guide (PDF) Network participation criteria We have a set of criteria for participation in our provider network. To find a participating provider, call eviCore at 800.298.4806 or go to Cigna.com > Find a Doctor. These guidelines are not intended to supersede or replace sound medical judgment, but instead should facilitate the identification of the most appropriate imaging procedure given the individual's clinical condition. E-Verify and IER Right to Work. a listing of the legal entities It's best to submit claims as soon as possible. They can easily Tailorize through their choices. that insure or administer group HMO, dental HMO, and other products or services in your state). eviCore's clinical guidelines are evidence-based and apply to the following categories of service for individuals with Cigna-administered plans: Computed Tomography (CT) and Computed Tomography Angiography (CTA) Magnetic Resonance Imaging (MRI) and Magnetic Resonance Angiography (MRA) Positron Emission Tomography (PET) Nuclear Cardiology For provider resources or customer service: Provider Resources www.eviCore.com/Resources/Healthplan/Cigna-Medicare, Clinical Guidelines: www.eviCore/com/Provider/Clinical-Guidelines, Web Portal Support:Email: PortalSupport@eviCore.comCall: 1 (800) 646-0418 (option 2), Non-Precertification Inquiries:ClientServices@eviCore.comCall: 1 (800) 575-4517 (option 3), Clinical Support/Program Inquiries:Email: ClientServices@eviCore.comCall: 1 (888) 693-3211Fax: 1 (888) 693-3210, Medical Oncology:Call: 1 (866) 668-9250Fax: 1 (800) 540-2406, Radiation Therapy:Call: 1 (866) 686-4452Fax: 1 (866) 699-8128, Provider Resources:Call: 1 (888) 693-3297Fax: 1 (888) 693-3210Send clinical questions/case examples to eviCores client and provider service team, Clinical Support/Program Inquiries:Email: ClientServices@eviCore.comCall: 1 (800) 298-4806PAC Fax: 1 (800) 575-4429HHC Fax: 1 (855) 826-3724, Call: 1 (866) 686-4452Fax: 1 (866) 663-7740. Member Rights Policy | Cigna may not control the content or links of non-Cigna websites. Visit the Provider Portal at HSConnectOnline.com. eviCore's clinical guidelines may include information inapplicable to benefit plans administered by Cigna. For Cigna Medicare membership guidelines click here. When you have the right tools, you can give your patients the care they deserve. Facilities considered for the Cigna LifeSOURCE Transplant N etwork must be a Cigna-participating provider and maintain hospital accreditation (e.g., Joint Commission of Hospital 3 0 obj For availability, costs and complete details of coverage, contact a licensed agent or Cigna sales representative. Provider manuals You will find guides to support you in providing care, managing your practice and working with us. Appeals and Disputes HIPAA Transaction Standards Questions? These guidelines apply to Cigna Medicare Advantage customers. endstream endobj startxref hbbd``b` SK(La "$[" rD @Ua$"C 6#I#s Z Delivering medical providers with important news, including: Updates to Cigna's policies and procedures Announcements of new Cigna electronic tools and services Clinical, pharmacy, and Medicare Advantage updates Health-related news, trends, and more Read the current issue Behavioral Health: Transformations By using this site, you acknowledge that this material is copyrighted and agree to the terms and conditions noted above. %%EOF Selecting these links will take you away from CignaforHCP.com. endstream endobj 59 0 obj <>>> endobj 60 0 obj <. Find PA forms at MedicareProviders.Cigna.com > Forms and Practice Support > Prior Authorization Requirements. To make updates , please notify QualCare Provider Relations. Watch this presentation to learn more about cultural competence and the important role you play as a provider. <> stream CHCP - Resources - Medical Reference Guides Commercial Medical Reference Guides Medical Reference Guides Here you'll find reference guides to help make it easier for health care professionals to do business with Cigna. eviCore has a national network of providers who offer these services. We're here to help. All Rights Reserved. For availability, costs and complete details of coverage, contact a licensed agent or Cigna sales representative. Durable medical equipment (including orthotics and prosthetics), home health, and home infusion As of February 1, 2021, eviCore healthcare (eviCore) manages home health care, durable medical equipment (DME), and home infusion therapy for Cigna commercial customers. However, the filing limit is extended another full year if the service was provided during the last three months of the calendar year. HEALTH CARE PROFESSIONALS PROVIDER MANAUL MEDICARE ADVANTAGE PCOMM -2021-1083 8/21 HEALTH CARE PROFESSIONALS PROVIDER MANAUL MEDICARE ADVANTAGE 2021 Return to Table of Contents Page 2of 113 All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation. %PDF-1.6 % CoverMyMeds: Website: CoverMyMeds.com (Preferred)Call: 1 (877) 813-5595Fax: 1 (866) 845-7267, 2022 Medicare Advantage Drug Formulary: MedicareProviders.Cigna.com > Pharmacy Resources, To evaluate patient eligibility for a patient support program, access our Patient Support Programs: MedicareProviders.Cigna.com > Patient Support Programs. Cigna.com no longer supports the browser you are using. Additional clinical guidelines may be developed as needed or may be withdrawn from use. 0 You may save, download and print these guides for use in your office. Medicare and commercial manuals 2022 Provider manual for physicians, hospitals and healthcare providers - effective March 15, 2022 2022 Provider manual for physicians, hospitals and healthcare providers - delegation - effective March 15, 2022 2023 Provider manual for physicians, hospitals and healthcare providers - effective March, 1 2023 % Claims questions: 1 (800) 230-6138 | Appeals questions: 1 (800) 511-6943 | Fax: 1 (800) 931-0149Electronic claims may be submitted through: Paper Claims: Cigna Medicare Advantage, PO Box 981706, El Paso, TX 79998Appeals: Cigna Medicare Advantage Appeals, PO Box 188081, Chattanooga, TN 37422Reconsideration Requests: Cigna Medicare Advantage Reconsiderations, PO Box 20002 Nashville, TN 37202, Mail: Cigna Medicare AdvantageAttn: Special Investigations UnitPO Box 20002, Nashville, TN 37202, Email: SpecialInvestigations@Cigna.comAttn: Cigna Medicare Operations. This web site uses files in Adobe Acrobat Portable Document Format (PDF). Encouraging patients to get vaccinated. Medicare (Cigna for Seniors): In accordance with Medicare processing rules, non-participating health care providers have 15 to 27 months to file a new claim. 75 0 obj <>/Filter/FlateDecode/ID[<6199C9EC628D61409439B9F09F0CF70A>]/Index[58 71]/Info 57 0 R/Length 86/Prev 105393/Root 59 0 R/Size 129/Type/XRef/W[1 2 1]>>stream If services are rendered on consecutive days, such as for a hospital confinement, the limit will be counted from the last date of service. Cigna insurance, now, offers both PPO and HMO plans. For additional information about the Modifier 25 - Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service reimbursement policy please watch this brief video. For additional information on our coverage and reimbursement of the COVID-19. All material on this website is, unless otherwise stated, the property of eviCore healthcare. of authorization request(s). Details Apr 14, 2023 Feedback Will open a new window Delivering medical providers with important news, including: Connecting Behavioral Health Care Providers with recent news. Coverage determinations in each specific instance require consideration of: eviCore's guidelines are based upon major national and international association and society guidelines and criteria, peer-reviewed literature, major treatises, and input from health plans, practicing academic and community-based physicians. Details. Annual Utilization Statistics | We take on the administrative burden so you can focus on getting patients the care they need, and get paid in a timely manner. To order eviCore-provided services for your patients with Cigna-administered coverage, contact a participating provider. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna. Copyright and other intellectual property laws protect these materials. eviCore has a national network of providers who offer these services. Privacy Policy | 3277 0 obj <>stream This website is not intended for residents of New Mexico. 5281 0 obj <>stream <> If you have any questions or would like more information about participating in a Cigna health care network, please contact us. 6T O'@j8*r', ;#Na-16|=i8IO_K$ _v:s+)"{%#YdQA=2A`,?6P~<4?EE`GD*8j 5pg, =dn/G~5i/!,A1R5n12&A{@ &`" _X)Z$K:PQ84H&TiXh|eOJDK E@0Rkg,_c"3?KpmJT. @ >9{$I@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@`t3186?;>YY_H@kukU%dL@3!7aPf47J@&2@#j8H8N YBiYB`h2052b4e"F GfCIUKF3L[e%,d Y gY")% y\ UP2 M|1B~ The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna. Provider Customer Service: 1 (800) 230-6138, Provider Website: MedicareProviders.Cigna.com, Provider Manual: 2022 Provider Manual [PDF], ID Card Examples: 2022 Provider Manual [PDF] > Customer Identification Cards, Provider Portal: HSConnectOnline.comHelp Desk: 1 (866) 952-7596Email: HSConnectHelp@HSConnectOnline.com, ICD-10 Coding & Documentation/360 Comprehensive Assessment:Provider Education and Assessment Tools, Quest Diagnostic LaboratoriesCall: 1 (866) 697-8378. Beginning Friday, December 18th at 5:00pm EST, you If these clinical guidelines are inconsistent with the terms of the individual's specific coverage plan, then the terms of the individual's coverage plan always takes precedence. Bardy Diagnostics, Inc. dba BDx Solutions, Inc.: Boston Scientific (Preventice Services, LLC): Pacemaker Monitoring Center, Inc. dba Cardiac Monitoring Center: International normalized ratio services and rapid diagnostic test to measure clotting time for patients using blood thinners. See the criteria (PDF) Office manual for health care professionals As of February 1, 2021, eviCore healthcare (eviCore) manages home health care, durable medical equipment (DME), and home infusion therapy for Cigna commercial customers. 3250 0 obj <> endobj 2021 Medicare Provider Manual Cigna Medicare Advantage Providers in Arizona PCOMM-2021-1081-AZ 8/21 ARIZONA HEALTH CARE PROFESSIONALS PROVIDER MANUAL MEDICARE ADVANTAGE 2021 Page 2of 104 All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation. wont be able to apply to eviCore openings. Cigna may not control the content or links of non-Cigna websites. Cigna does not control the linked sites' content or links. hb```, cb@1FFAA/j8Dcj29vPh Details. Provider customer service 1.800.230.6138 Provider website MedicareProviders.Cigna.com Provider manual MedicareProviders.Cigna.com > 2023 Provider Manual ID card examples MedicareProviders.Cigna.com > 2023 Provider Manual > 2023 Customer Identification Cards Provider portal HSConnectOnline.com Help Desk: 1.866.952.7596 Email: HSConnectHelp@ Cigna contracts with Medicare to offer Medicare Advantage HMO and PPO plans and Part D Prescription Drug Plans (PDP) in select states, and with select State Medicaid programs. If Medicare is the Secondary Payer (MSP), the initial claim must be submitted to the primary payer within Cigna's timely filing period. Q1: Overall, how satisfied are you with eviCores website? Whether you need to stay informed on Cigna policies, want to check out an informative webinar, or are looking for the latest news on Medicare, youll find it here with our newsletters, dedicated to keeping health care providers at the top of their game. guidelines at-a-glance flyer or visit our updated provider COVID-19 web page at CignaforHCP.com. 1 0 obj that insure or administer group HMO, dental HMO, and other products or services in your state). IMPORTANT: In the coming days, we will be migrating systems for our endstream endobj 4811 0 obj <. From professional newsletters to wellness programs to Cigna medical plans and more, this is the medical health care professional's source for information. Enrollment in Cigna depends on contract renewal. ALL RIGHTS RESERVED. Reproduction or retransmission of the materials, in whole or in part, in any manner, without the prior written consent of the copyright holder, is a violation of copyright law. endobj a listing of the legal entities Provider Reference Guide - Baylor Scott & White Health Plan To know the process of editing PDF document or application across the online platform, you need to follow these . If Medicare is the primary payer, timely filing is determined from the processing date indicated on the primary carrier's explanation of benefit (EOB). eviCore's clinical guidelines are evidence-based and apply to the following categories of service for individuals with Cigna-administered plans: The terms of an individual's particular coverage plan document [Group Service Agreement (GSA), Evidence of Coverage, Certificate of Coverage, Summary Plan Description (SPD), or similar plan document] may differ significantly from the standard coverage plans upon which these guidelines are based. 2021 when submitted under Cigna commercial medical benefit plans. Ethics & Compliance | 0 Cultural competency training video. hbbd```b``kd d im "YC'`S`q{4.F wHeg`bdq m#@g l< The services and national providers are outlined below: www.eviCore.com/resources/healthplan/Cigna, Beds, wheelchairs, walkers, scooters, off-the-shelf DME (e.g., braces, splints, slings), and compression (tight-fitting) clothing for all body areas to help post-surgery healing and improve circulation, Prefabricated and fabricated (custom) O&P, postmastectomy supplies (i.e., bras, forms, and compression sleeves), and wigs, Oxygen, continuous positive airway pressure equipment, and ventilators, Anti-infective therapy, total parenteral nutrition, pain management, inotropic therapies, immune globulin, enzyme replacement, and REMICADE, Nursing, therapies, social work, and home health aides, Insulin pumps and supplies, continuous passive motion machines and supplies, wound vacuums and supplies, and breast pumps, Provider contracting, credentialing, and demographic updates, Claims processing for Shared Administration Repricing and Payer Solutions customers, Initial precertification requests (forwards precertification request/information over to Cigna), Claims processing, except for Shared Administration Repricing and Payer Solutions customers, Customer-based services, including benefits, eligibility, and appeals, Provider and customer denial letters for services that are not authorized, Cardiology devices and equipment and heart monitoring equipment and services, including arrhythmia monitors, Holter monitors, and digital and wireless monitoring. Good health and a good doctor/patient relationship begins with understanding your patients' cultural, ethnic, racial and linguistic needs. hTkSW?%yy$^5%VS&`Zc/JPZi(t45?lM.X Vb!1ZP&V8f[_2r}Iss/ 0S3UU%j9(UTT ( As a valued user of our website, wed appreciate your feedback to help us improve your website experience. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. All clinical products and services of the LivingWell Health Centers are either provided by or through clinicians contracted with HealthSpring Life & Health Insurance Company, Inc., HealthSpring of Florida, Inc., Bravo Health Mid-Atlantic, Inc., and Bravo Health Pennsylvania, Inc. or employees leased by HS Clinical Services, PC, Bravo Advanced Care Center, PC (PA), Bravo Advanced Care Center, PC (MD) and not by Cigna Corporation. Selecting these links will take you away from Cigna.com to another website, which may be a non-Cigna website. 5 0 obj Get Adobe Reader. Accidental Injury, Critical Illness, and Hospital Care plans or insurance policies are distributed exclusively by or through operating subsidiaries of Cigna Corporation, are administered by Cigna Health and Life Insurance Company, and are insured by either (i) Cigna Health and Life Insurance Company (Bloomfield, CT); (ii) Life Insurance Company of North America (LINA) (Philadelphia, PA); or (iii) New York Life Group Insurance Company of NY (NYLGICNY) (New York, NY), formerly known as Cigna Life Insurance Company of New York. Request a Consultation with a Clinical Peer Reviewer, Check Status Of Existing Prior Authorization, Check Status of Existing Prior Authorization, Computed Tomography (CT) and Computed Tomography Angiography (CTA), Magnetic Resonance Imaging (MRI) and Magnetic Resonance Angiography (MRA), The terms of the applicable coverage plan document in effect on the date of service, Any relevant collateral source materials including clinical guidelines, The specific facts of the particular situation. Silver&Fit is a registered trademark of ASH and used with permission herein. However, these guidelines may not be applicable in certain clinical circumstances. All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation. CocoDoc has made it easier for people to Modify their important documents by online browser. Details, Applicable law requires a longer filing period, Provider agreement specifically allows for additional time, In Coordination of Benefits situations, timely filing is determined from the processing date indicated on the primary carrier's explanation of benefits (EOB) or explanation of payment (EOP). Medical and Dental 1 (800) 88CIGNA (882-4462) Behavioral 1 (800) 926-2273 Pharmacy Email us The Cigna Group Information Disclaimer Message Here. &+3gdn WZ!'H7}k+Vai|F_*H|NW _[GJ[okazk4Rw3iR\_[Jn2Y{beL_ek^ax66Pwwz^Hm/(1WLdrJ|zGLDDh @`l"L@SbOD4 E V&74Z}? Using these recommended billing guidelines and codes will help facilitate proper reimbursement and help to avoid errors and potential reimbursement delays. For information on Oscars policies and procedures, For the A to Z on Oscar's clinical criteria, For current state-specific reimbursement policies, For general Quality information and improvement guides. eviCore supports the work of physicians and others who strive to reduce the overuse of diagnostic tests that are of low value, of no value, or where the risks of a given diagnostic test are greater than the benefits. In addition to the RFI content , Cigna LifeSOURCE annually evaluates each transplant program to determine continued compliance with established guidelines . vaccine, please review our . This website is not intended for residents of New Mexico. Copyright 2022 eviCore healthcare. If a resubmission is not a Cigna request, and is not being submitted as an appeal, the filing limit will apply. If you have any questions or would like more information about participating in a Cigna health care network, please contact us. To learn more about a program, or request a patient eligibility evaluation, email CignaRefer_Help@Cigna.com. Your secure provider portal for working with Cigna The information, tools, and resources you need to support the day-to-day needs of your office are all on the Cigna for Health Care Providers' website, CignaforHCP.com : Check patient eligibility and benefits Check claims, payments, and fee schedules Update your Cigna provider directory information In general, Medicare does not consider a situation where (a) Medicare processed a claim in accordance with the information on the claim form and consistent with the information in the Medicare's systems of records and; (b) a third party mistakenly paid primary when it alleges that Medicare should have been primary to constitute "good cause" to reopen. Need help? Terms of Use | There are some exceptions to these deadlines. April 1 - September 30) Cigna Medicare Advantage Plans (Arizona Only) 1 (800) 627-7534 (TTY 711) 8:00 am 8:00 pm Mountain time, 7 days a week
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