Selecting these links will take you away from Cigna Medicare Advantage and Medicare Part D Prescription Drug Plan information. This website is not intended for residents of New Mexico. Thank you for using eviCores website today! They can easily Tailorize through their choices. 0 Individual and family medical and dental insurance plans are insured by Cigna Health and Life Insurance Company (CHLIC), Cigna HealthCare of Arizona, Inc., Cigna HealthCare of Illinois, Inc., Cigna HealthCare of Georgia, Inc., Cigna HealthCare of North Carolina, Inc., Cigna HealthCare of South Carolina, Inc., and Cigna HealthCare of Texas, Inc. Group health insurance and health benefit plans are insured or administered by CHLIC, Connecticut General Life Insurance Company (CGLIC), or their affiliates (see Selecting these links will take you away from Cigna.com to another website, which may be a non-Cigna website. We're here to help. 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. 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. ?siuC~62Ovxy:5igu+aF7c 2021 when submitted under Cigna commercial medical benefit plans. 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@ <> PDF COVID-19 MEDICARE ADVANTAGE BILLING & AUTHORIZATION GUIDELINES - Cigna Thank you for the quality care you provide to our members. %%EOF Individual and family medical and dental insurance plans are insured by Cigna Health and Life Insurance Company (CHLIC), Cigna HealthCare of Arizona, Inc., Cigna HealthCare of Illinois, Inc., Cigna HealthCare of Georgia, Inc., Cigna HealthCare of North Carolina, Inc., Cigna HealthCare of South Carolina, Inc., and Cigna HealthCare of Texas, Inc. Group health insurance and health benefit plans are insured or administered by CHLIC, Connecticut General Life Insurance Company (CGLIC), or their affiliates (see 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. %%EOF Health Care Providers | Cigna If a resubmission is not a Cigna request, and is not being submitted as an appeal, the filing limit will apply. 0 If Medicare is the primary payer, timely filing is determined from the processing date indicated on the primary carrier's explanation of benefit (EOB). For availability, costs and complete details of coverage, contact a licensed agent or Cigna sales representative. Oscar is an HMO with a Medicare contract. However, the filing limit is extended another full year if the service was provided during the last three months of the calendar year. Using these recommended billing guidelines and codes will help facilitate proper reimbursement and help to avoid errors and potential reimbursement delays. Read our quick-reference guide (PDF) Network participation criteria We have a set of criteria for participation in our provider network. Member Rights Policy | Beginning on 3/15/21, web users will be required to log in to evicore.com in order to check the status The website includes several educational materials: frequently asked questions documents, quick reference guides, provider training presentations, DME and O&P precertification form, and lists of Healthcare Common Procedure Coding System codes that require precertification through Cigna. As a valued user of our website, wed appreciate your feedback to help us improve your website experience. Provider Education & Manuals - Aetna 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 Provider manuals You will find guides to support you in providing care, managing your practice and working with us. Please call QualCare Provider Relations at 800.992.6613 if you have any questions or concerns. Medical and Dental 1 (800) 88CIGNA (882-4462) Behavioral 1 (800) 926-2273 Pharmacy Email us The Cigna Group Information Disclaimer %PDF-1.6 % a listing of the legal entities 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. of authorization request(s). Health Care Provider Newsletters | Cigna If services are rendered on consecutive days, such as for a hospital confinement, the limit will be counted from the last date of service. a listing of the legal entities ALL RIGHTS RESERVED. that insure or administer group HMO, dental HMO, and other products or services in your state). 58 0 obj <> endobj 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: [email protected], ICD-10 Coding & Documentation/360 Comprehensive Assessment:Provider Education and Assessment Tools, Quest Diagnostic LaboratoriesCall: 1 (866) 697-8378. All insurance policies and group benefit plans contain exclusions and limitations. Provider Reference Guide - Baylor Scott & White Health Plan Selecting these links will take you away from Cigna.com to another website, which may be a non-Cigna website. E-Verify and IER Right to Work. For availability, costs and complete details of coverage, contact a licensed agent or Cigna sales representative. 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 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: [email protected]: 1 (800) 646-0418 (option 2), Non-Precertification Inquiries:[email protected]: 1 (800) 575-4517 (option 3), Clinical Support/Program Inquiries:Email: [email protected]: 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: [email protected]: 1 (800) 298-4806PAC Fax: 1 (800) 575-4429HHC Fax: 1 (855) 826-3724, Call: 1 (866) 686-4452Fax: 1 (866) 663-7740. 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). 0 Cigna Coronavirus (COVID-19) Interim Billing Guidance for Providers for Commercial Customers Last updated February 15, 2023 - Highlighted text indicates updates The White House announced the intent to end both the COVID-19 national emergency and public health emergency (PHE) on May 11, 2023. 1 0 obj 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. Please click here to register for an account. Medicare patients' claims must be filed no later than the end of the calendar year following the year in which the services were provided. Helping you keep up with research, trends, and policy changes that impact your practice. PDF QANI Reference Guide for physicians, hospitals, ancillaries, and other Selecting these links will take you away from Cigna.com to another website, which may be a non-Cigna website. Provider Publications - Humana endstream endobj startxref Cigna does not control the linked sites' content or links. Additional clinical guidelines may be developed as needed or may be withdrawn from use. CHCP - Resources - Reference Guides - Cigna Other names or logos may be trademarks of their respective owners. Committed to cultural competency. Good health and a good doctor/patient relationship begins with understanding your patients' cultural, ethnic, racial and linguistic needs. 4828 0 obj <>/Filter/FlateDecode/ID[<6BC9DFFB7467AF4AB407F2A14C4E167D><84593DD970E2D74EA4BE0EDE70F6ABF6>]/Index[4810 472]/Info 4809 0 R/Length 127/Prev 809539/Root 4811 0 R/Size 5282/Type/XRef/W[1 3 1]>>stream It's best to submit claims as soon as possible. After one year and prior to four years from the date of determination, "good cause" is required for Medicare to reopen the claim. Cookies are not enabled, for best results please enable cookies. 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. endstream endobj 59 0 obj <>>> endobj 60 0 obj <. When you have the right tools, you can give your patients the care they deserve. On January 1, 2023, eviCore began managing the provider network for orthotics and prosthetics (O&P) services for Cigna commercial customers. Provider Resources - hioscar.com See the criteria (PDF) Office manual for health care professionals Report Fraud & Abuse | Enrollment in Cigna depends on contract renewal. CHCP - Resources - Durable medical equipment (including - Cigna For prior authorizations, access our interactive Prior Authorization Requirements (a searchable reference guide updated quarterly) at MedicareProviders.Cigna.com > Forms and Practice Support > Prior Authorization Requirements. endstream endobj startxref 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. For additional information on our coverage and reimbursement of the COVID-19. 1 Cigna may request appropriate evidence of extraordinary circumstances that prevented timely submission (e.g., natural disaster). 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. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna. To find a participating provider, call eviCore at 800.298.4806 or go to Cigna.com > Find a Doctor. Cigna may not control the content or links of non-Cigna websites. we will be implementing changes to evicore.com in the near future. hbbd``b` SK(La "$[" rD @Ua$"C 6#I#s Z All insurance policies and group benefit plans contain exclusions and limitations. When to File Claims | Cigna %PDF-1.4 @ >9{$I@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@`t3186?;>YY_H@kukU%dL@3!7aPf47J@&2@#j8H8N YBiYB`h2052b4e"F GfCIUKF3L[e%,d Y gY")% y\ UP2 M|1B~ If you have any questions or would like more information about participating in a Cigna health care network, please contact us. <> Cigna insurance, now, offers both PPO and HMO plans. In addition to the RFI content , Cigna LifeSOURCE annually evaluates each transplant program to determine continued compliance with established guidelines . If you have any questions or would like more information about participating in a Cigna health care network, please contact us. Medical technology is continuously evolving; the guidelines undergo a formal review annually, however eviCore reserves the right to change and update the guidelines without prior notice. %PDF-1.5 % eviCore has a national network of providers who offer these services. This website is not intended for residents of New Mexico. Privacy Policy | All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation. Q1: Overall, how satisfied are you with eviCores website? Message Here. 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. CHCP - Resources - Clinical Reimbursement Policies and Payment - Cigna eviCore's clinical guidelines may include information inapplicable to benefit plans administered by Cigna. Cultural competency training video. providers according to plan rules as listed in the online provider manual. Cigna Billing Manual Form: Fillable, Printable & Blank PDF Form for 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. hb``b``Ab,nF )H\g```h i~ a,g}]Ig]7 1fq61` v T ob!!|Fy JC Cigna | eviCore CHCP - Resources - Cigna's response to COVID-19 However, these guidelines may not be applicable in certain clinical circumstances. To make updates , please notify QualCare Provider Relations. &+3gdn WZ!'H7}k+Vai|F_*H|NW _[GJ[okazk4Rw3iR\_[Jn2Y{beL_ek^ax66Pwwz^Hm/(1WLdrJ|zGLDDh @`l"L@SbOD4 E V&74Z}? a listing of the legal entities hb```, cb@1FFAA/j8Dcj29vPh vaccine, please review our . Details. 3 0 obj 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: [email protected]: Cigna Medicare Operations. 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. There are some exceptions to these deadlines. 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. hbbd```b`:" l,3!V "@|j0$> 0L[+&00Fr G(9J'(9Ft5JJgx s endobj These guidelines are written to cover medical conditions as experienced by the majority of individuals. eviCore positions. Network Insider Medicare Provider Newsletter, Provider Portal Claimstat Login Arizona Providers Only, www.eviCore.com/Resources/Healthplan/Cigna-Medicare, www.eviCore/com/Provider/Clinical-Guidelines. To submit a Prior Authorization request:Visit the Provider Portal at HSConnectOnline.com. In order to have the best experience on Cigna.com, Javascript needs to be enabled. reCAPTCHA is not valid; Please try again! 5281 0 obj <>stream If a claim was timely filed originally, but Cigna requested additional information. Get Adobe Reader. Details Apr 14, 2023 Feedback Will open a new window Visit the Provider Portal at HSConnectOnline.com. eviCore has a national network of providers who offer these services. We are committed to ensuring that your participation in the QualCare network is a positive and beneficial experience. Cigna.com no longer supports the browser you are using. PDF 2021 Medicare Provider Manual Cigna Medicare Advantage Providers in Arizona CHCP - Resources - Medical Reference Guides - Cigna 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. We'll discuss the salient differences between them to make selection easier - and more accurate - for you: Provider networks Unlike in an HMO plan where you must visit your PCP and maintain one all year-long, you don't have to do that. Annual Utilization Statistics | Details. This is useful for forms that you want to view and/or print. 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. wont be able to apply to eviCore openings. PDF Provider Quick Reference Guide - Cigna 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). Cigna may not control the content or links of non-Cigna websites. General Information: 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.com Help Desk: 1 (866) 952-7596 Email: [email protected] ICD-10 Coding & Documentation/ 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 Quick Reference Guide | Cigna Medicare Providers 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. Clinical decisions, including treatment decisions, are the responsibility of the individual and his/her provider. 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. Updates to Cigna's policies and procedures, Announcements of new Cigna electronic tools and services, Clinical, pharmacy, and Medicare Advantage updates. These guidelines apply to Cigna Medicare Advantage customers. If you're unable to file a claim right away, please make sure the claim is submitted accordingly. Coverage and Claims | Cigna *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * 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. Appeals and Disputes HIPAA Transaction Standards Questions? This website is not intended for residents of New Mexico. 3250 0 obj <> endobj PDF PROVIDER REFERENCE GUIDE - Cigna, a Global Health Insurance and Health Ethics & Compliance | endstream endobj startxref As of February 1, 2021, eviCore healthcare (eviCore) manages home health care, durable medical equipment (DME), and home infusion therapy for Cigna commercial customers. hd|(3bECB!_,BM@2sjn&+_C+S3 kg|N0=8fx8P T! PDF Health Care Professionals Provider Manaul Medicare Advantage 4810 0 obj <> endobj Copyright and other intellectual property laws protect these materials. 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. If Medicare is the Secondary Payer (MSP), the initial claim must be submitted to the primary payer within Cigna's timely filing period. 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. 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. hbbd```b``kd d im "YC'`S`q{4.F wHeg`bdq m#@g l< 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 From professional newsletters to wellness programs to Cigna medical plans and more, this is the medical health care professional's source for information. To search the Prior Authorization guide for a code, enter Ctrl+F > the 5-digit code. Beginning Friday, December 18th at 5:00pm EST, you 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.
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