Physician Health Care Provider. Quick Reference. CIGNA HealthCare 2006
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1 & Physician Health Care Provider Quick Reference CIGNA HealthCare
2 Contents Provider Value Proposition 3 Overview 4 Electronic Services 6 Working with Us 17 Contact Information 21 2 Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. Copyright 2006 CIGNA
3 Provider Value Proposition CIGNA is committed to working collaboratively with providers to deliver innovative solutions that... Support delivery of quality health care to their patients (CIGNA s members) by providing information that helps manage patient care more effectively and empowers patients to take an active role in their health care, partnering with their physician. Shorten their revenue cycle by improving CIGNA payment information and processes; including consumer liability (patient bad debt) solutions. Minimize administrative costs and reduce the complexity of doing business with CIGNA by minimizing intrusive and ineffective policies and programs and by emphasizing electronic data exchange and selfservice. 3 Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. Copyright 2006 CIGNA
4 Overview CIGNA is committed to working with you to provide our members/your patients access to quality services and benefits. We offer comprehensive tools to assist you and your staff in administering the CIGNA HealthCare programs and administrative policies. This presentation outlines several key components of our programs and provides guidance for us to effectively work together. For additional information on our benefit plans, medical management process and policies and/or procedures, please register for our secure website as outlined on the following pages. 4 Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. Copyright 2006 CIGNA
5 Electronic Services Physician & Health Care Provider Quick Reference 5 Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. Copyright 2006 CIGNA Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. Copyright 2006 CIGNA
6 Electronic Services at a Glance CIGNA for Health Care Professionals website: Electronic Claim Submission two options Post-N-Track (direct submission to CIGNA HealthCare) Clearinghouse Electronic Funds Transfer/Direct Deposit Direct deposit of CIGNA HealthCare payments into your account Electronic Remittance Advice Electronic equivalent of an Explanation of Payment for processed claims 6 Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. Copyright 2006 CIGNA
7 CIGNA for Health Care Professionals Website CIGNA for Health Care Professionals website: Convenient, easy access to information and transactions Delegate access to office staff Multiple-user capability Includes member benefit information and claim status 7 Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. Copyright 2006 CIGNA
8 CIGNA for Health Care Professionals Website Benefit plan descriptions Claim appeals policy Claim requirements Claim status and details Coverage positions Disease management programs Eligibility and benefit information Fee schedule requests Forms Precertification information Pharmacy formulary Procedure code bundling edits Provider directory Provider reference guides Visit our online demo at and register online 8 Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. Copyright 2006 CIGNA
9 CIGNA for Health Care Professionals Home Page View an interactive demo of the website Get help navigating and registering to use the website 9 Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. Copyright 2006 CIGNA
10 CIGNA for Health Care Professionals e-services Page See Patient Eligibility and Benefits, Claim Status and CPT /HCPCS procedure codes and edits Inquire about: Coverage positions and submit a request for a coverage position not yet posted on our website Whether specific medical services, procedure or supplies are covered under a member s benefit plan Fee schedules for specific CPT /HCPCS procedure codes or a range of codes View default fee schedule changes, update demographics and request a copy of your participating provider agreement 10 Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. Copyright 2006 CIGNA
11 CIGNA for Health Care Professionals Medical Resources This page provides valuable information on a wealth of topics 11 Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. Copyright 2006 CIGNA
12 Electronic Claim Submission Electronic claim submission can offer these advantages: Reduced paperwork and improved productivity Reduced costs Faster claim delivery and feedback Improved claim accuracy 12 Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. Copyright 2006 CIGNA
13 Post-N-Track Post-N-Track is a way for you to submit claims directly to us Enrollment and information at Accepts any number of claims at no cost (you are responsible for Internet service provider fee) Claims are sent directly to CIGNA HealthCare Secure and HIPAA-compliant process Compatible with most existing systems Reports available: ANSI 997 Acknowledgements ANSI 277 Status ANSI 835 Remittance responses 13 Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. Copyright 2006 CIGNA
14 Clearinghouse A clearinghouse acts as a liaison between you and CIGNA HealthCare when submitting claims electronically For more information, contact Emdeon: One electronic payer ID for all CIGNA HealthCare: Note: Not all clearinghouses transmit directly to CIGNA. Claims may go through one or more vendors before arriving at CIGNA, which can increase submission time. Post-N-Track transmits directly to CIGNA in real-time, eliminating any additional handling. 14 Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. Copyright 2006 CIGNA
15 Electronic Funds Transfer/Direct Deposit Electronic Funds Transfer and Direct Deposit can offer these advantages: Improved cash flow Avoidance of mailing delays Potential for increased administrative efficiency Secure process Registration information available at: 001_eraeft_directdeposit.html Direct Deposit Activity Report/Electronic Remittance Advice Details for claims processed and the payments included in that EFT Separate report for each EFT 15 Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. Copyright 2006 CIGNA
16 Working with Us Physician Health Care & Provider Quick Reference 16 Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. Copyright 2006 CIGNA Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. Copyright 2006 CIGNA
17 Claim Submission Remember: Electronic claim submission can improve claim accuracy To help ensure timely, accurate claim payment, complete these boxes for each claim submission: CMS 1500 UB92 Box 25 Box 31 Box 33 Box 1 Box 5 The contracted entity s Tax ID number The rendering health care provider s name The Tax ID owner s name, billing address and telephone number as reported to the IRS The Tax ID owner s name, billing address and telephone number as reported to the IRS The contracted entity s Tax ID number CIGNA HealthCare requires a sample claim form prior to executing a new contract. Verify the information submitted on your claim forms is consistent with the information supplied during the contracting process. If any information changes, contact us. Update information online at or download a copy of our demographic change form. 17 Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. Copyright 2006 CIGNA
18 Claim Submission, cont. Find detailed information about claim submission and requirements in our Provider Reference Guides Access online at go to Provider Site Index Select Hospital & Ancillary Facility Guide or Physician & Health Care Practitioner Guide for your location Topics covered: Complete claim definition Timely filing requirements Claim processing policies Coordination of benefits Explanation of Payment 18 Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. Copyright 2006 CIGNA
19 Appeals Two-level appeal process to resolve disputes: First level must be initiated within 180 calendar days of the date of initial payment or denial decision Second level must be initiated within 60 calendar days of the date of the first-level decision letter Submit appeals to: PO Box 5225 Scranton, PA Additional details for filing and Request for Payment Review Form are posted on Note: For details on California dispute policies, refer to the claim appeal information posted at 19 Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. Copyright 2006 CIGNA
20 Contact Information Physician Health Care & Provider Quick Reference 20 Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. Copyright 2006 CIGNA Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. Copyright 2006 CIGNA
21 Contact Us Visit Call CIGNA ( ) Offers access to the information you need most using a telephone: Eligibility Benefits Claim status Precertification Credentialing status Speak with a Representative Interactive Voice Response (IVR) available at any time to hear certain requested information immediately or have it returned via fax 21 Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. Copyright 2006 CIGNA
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