CO NTENTS
FEATURE ARTICLE
MEDICARE NEWS
100 Cigna Collaborative Care arrangements
reach one million Cigna customers
Tips to avoid administrative claim denials
14
Cigna Medicare Advantage Plan earns
high CMS star ratings
14
2
POLICY UPDATES
Precertification changes
4
PHARMACY NEWS
Clinical, reimbursement, and administrative
policy updates
5
Preferred hyaluronates added to
Cigna drug list
Precertification requirement for Cigna
Global Health Benefits customers
5
ELECTRONIC TOOLS
New ICD-10 compliance date
6
Get paid faster
6
HEALTH CARE REFORM NEWS
Cigna’s proprietary retail exchange
launches nationally
7
CONNECTED CARE
Cigna and Samsung score with new
“Coach by Cigna” app
16
Cigna programs and technology
driving health & wellness
17
New York and Texas – Out-of-network
disclosure forms
18
HELPFUL REMINDERS
8
Improved health care professional directory 9
Help keep medical costs down by referring
Cigna customers in network
Coverage of breast cancer prevention drugs 15
REGIONAL NEWS
GENERAL NEWS
Shared administration program and
tobacco cessation
15
9
Market Medical Executives
contact information
19
Reference Guides
19
Go green–go electronic
20
20
Cigna Care designation 101
10
Urgent care for non-emergencies
Cigna ID card changes
10
Cultural competency training and resources 20
Cigna Centers of Excellence
11
Important reminder: Missouri claim
mailroom closed July 1, 2014
Have you moved recently? Did your
phone number change?
21
12
Access the archives
21
Health care professional agreements –
final phase of contract entity change
12
Letters to the editor
21
National Committee for Quality Assurance
updates quality measure for Controlling
High Blood Pressure
12
LocalPlus network expanding to
new markets
13
Helping your patients save on
radiology services
13
FEAT UR E A R T I C L E
100 Cigna Collaborative Care arrangements
reach one million Cigna customers
Cigna has been at the forefront of the accountable
care organization movement since 2008 when it
launched its first patient-centered initiative in New
Hampshire. Building on the success of that early
initiative, and others like it in Arizona and Texas,
in 2012 we set an ambitious goal to have 100
Cigna Collaborative Care arrangements with large
physician groups in 2014 that would reach one
million customers. Earlier this year, we achieved
that goal.
“We’re thrilled that we’ve reached the milestone of
100 Cigna Collaborative Care arrangements with
some of the most forward-thinking large physician
groups in the country,” said Alan M. Muney, MD,
Cigna’s Chief Medical Officer. “The leaders of these
organizations are fully committed to collaborating
with us and recognize the value of delivering
better health, affordability, and experience.”
Among the arrangements that have been operational
for two or more years:
› 73 percent have met targets for improving quality
› 73 percent have met targets for controlling total medical cost
› 55 percent have met targets for both quality and total medical cost
› On average, these arrangements have demonstrated three percent
better than market average total medical cost and two percent
better than market average quality
Among arrangements that have been operational for at
least one year:
› 63 percent have met targets for improving quality
› 50 percent have met targets for controlling total medical cost
› 37 percent have met targets for both quality and total medical cost
› These arrangements have been at par with market average total
medical cost and two percent better than market average quality
Results
In places where it’s been introduced, Cigna
Collaborative Care is helping to improve the health
of Cigna customers while holding the line on
medical costs. The programs are helping to close
gaps in care, such as missed health screenings
or prescription refills, reducing unnecessary use
of hospital emergency rooms, increasing the
number of preventive health visits, and improving
follow-up care for people transitioning from
the hospital to home. Cigna Collaborative Care
physician groups earn additional “pay-for-value”
reimbursement when they achieve targets for both
quality and affordability.
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CIGNA NETWORK NEWS
•
OCTOBER 2014
“These results, especially the strong performance
by our most mature arrangements, show what’s
possible through sustained collaboration over
time,” Muney noted. “In order to have achieved
substantial impacts on quality and affordability,
these medical groups have implemented best
practices across their physician and clinical support
teams to use the new information and resources
from Cigna that are available to help them.”
Five keys to collaborative care success
The success of Cigna Collaborative Care arrangements can be attributed to five key features that help enable our health
care professionals to drive affordability, quality, and an overall better experience for their Cigna patients.
Actionable,
patient-specific
information
Embedded care
coordinators
Consultative
clinical
resources
Health care
professional
Learning
collaboratives
Clinical
programs
The 100 Cigna Collaborative Care arrangements with large physician groups span 27 states, reach more than one million
commercial customers and encompass more than 39,000 doctors, including more than 19,000 primary care physicians and
more than 20,000 specialists.
CIGNA NETWORK NEWS
•
OCTOBER 2014
3
P OL I CY UPDAT E S
Precertification changes
On October 1, 2014, the American Medical Association (AMA) and
Centers for Medicare & Medicaid Services (CMS) released new
CPT® and HCPCS codes. Codes released as part of their updates
were reflected on our precertification list this month.
Also on October 1, 2014, we updated our list of existing CPT
and HCPCS codes to include eight additional codes that require
precertification. At that time, we also removed four codes from the
precertification list.
The precertification list on the Cigna for Health Care Professionals
website (CignaforHCP.com) reflects these updates.
To view the complete list of services requiring precertification
of coverage, please log in to CignaforHCP.com and click on
Precertification Policies under Useful Links. If you are not currently
registered for the website, you will need to register to log in. Go to
CignaforHCP.com and click on “Register Now.”
Codes added to the precertification list on October 1, 2014
CODE
DESCRIPTION
C9023
Injection, testosterone undecanoate, 1 mg.
C9025
Injection, ramucirumab, 5 mg.
C9026
Injection, vedolizumab, 1 mg.
C9135
Factor XIII (antihemophilic factor, recombinant), Alprolix, per 10 i.u.
C9741
Right heart catheterization with implantation of wireless pressure sensor in the pulmonary artery, including any
type of measurement, angiography, imaging supervision, interpretation, and report; includes provision of patient
home electronics unit.
Q9972
Injection, Epoetin Beta, 1 microgram, (For ESRD on Dialysis)
Q9973
Injection, Epoetin Beta, 1 microgram, (Non- ESRD use)
S8032
Low-dose computed tomography for lung cancer screening
Codes no longer requiring precertification on October 1, 2014*
CODE
DESCRIPTION
15789
Chemical peel, facial; dermal
15793
Chemical peel, non-facial; dermal
0346T
Ultrasound, elastography (list separately in addition to code for primary procedure)
E0745
Neuromuscular stimulator, electronic shock unit
* Removal of codes from the precertification requirement list is not a guarantee of payment. Codes may be subject to code editing, benefit plan exclusions, and post service review for coverage.
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CIGNA NETWORK NEWS
•
OCTOBER 2014
Clinical, reimbursement, and
administrative policy updates
To support access to quality, cost-effective care for your patients
with a Cigna insured or administered medical plan, we routinely
review clinical, reimbursement, and administrative policies as
well as our medical coverage positions, and our precertification
requirements. As a reminder, reimbursement and modifier
policies apply to all claims, including those for your patients
with GWH-Cigna or “G” ID cards.
The following table lists planned updates to our coverage
policies. Information about these changes, including an
outline of the specific updates, is available on the Cigna
for Health Care Professionals website (CignaforHCP.com >
Resources > Clinical Reimbursement Policies > Coverage
Policy Updates) at least 30 days prior to the effective date of
the updated policy. On this page, you may also view new and
updated policies in their entirety.
Planned medical policy updates
POLICY NAME
UPDATE
EFFECTIVE DATE
Facility Routine Services and Supplies
October 20, 2014
Healthcare Common Procedure
Coding System (HCPCS)
October 20, 2014
National Level II Modifier Policy
(Modifier SU)
If you are not registered for CignaforHCP.com, please register so
you may log in and access these policies. Go to CignaforHCP.com
and click “Register Now.” If you do not have Internet access, please
call Cigna Customer Service at 1.800.88Cigna (882.4462).
Precertification requirement for
Cigna Global Health Benefits customers
As a reminder, precertification is now required for inpatient,
and certain outpatient, services that are rendered in the
United States to Cigna Global Health Benefits® (CGHB)
customers. ID cards for customers of CGHB were updated
to indicate that inpatient and outpatient services require
precertification. These ID cards also include Customer
Service contact information, which can be used to request
precertification.
For more information about our precertification policy or
for the complete list of services requiring precertification,
please visit the Cigna for Health Care Professionals website
at CignaforHCP.com > Resources > Clinical Reimbursement
Policies and Payment Policies > Precertification Policies. If
you are not a registered user, you will need to register to log
in to access these policies. Go to CignaforHCP.com and click
“Register Now.”
What do you need to do differently?
Additional information
You should now call CGHB Customer Service at 1.800.441.2668
to request precertification for inpatient, and certain
outpatient, services for these customers. Please be aware that
precertification does not guarantee coverage and treatments
or services that require precertification will not be covered
unless precertification was obtained.
If you would like additional information about this update, or
if you do not have Internet access, please call CGHB Customer
Service at 1.800.441.2668.
CIGNA NETWORK NEWS
•
OCTOBER 2014
5
E LECTR ONIC TO O L S
New ICD-10
compliance date
On July 31, 2014, the U.S. Department of Health
and Human Services announced the new ICD-10
compliance date as October 1, 2015.
In the year ahead
We will continue our transitional work on ICD-10
and await further direction from the Centers of
Medicare & Medicaid Services.
We recommend that all health care
professionals and facilities continue ICD-10
remediation and training efforts to help
ensure you are prepared to transition by
October 1, 2015. Here are some suggestions:
› If you use an electronic medical record,
verify with your vendor that the system is
ICD-10 compliant.
› If you use a superbill form to document
the patient visit, update the form to reflect
both ICD-9 and ICD-10 diagnosis codes so
you can become familiar with the ICD-10
equivalent.
› Continue with ICD-10 coding and
documentation training for your clinical
staff and medical coders.
› Focus on adding greater specificity to
clinical documentation. In your clinical
notes, indicate location or laterality,
encounter type, acute versus chronic,
degree of illness, and more.
You can also refer to industry resources for help
with preparation, including the following:
› Centers for Medicare & Medicaid Services:
Road to 10 (CMS.gov > Medicare > ICD-10
> ICD-10), an online resource built with
the help of health care professionals in
small practices. This tool is intended to
help small medical practices jump-start
their ICD-10 transition.
We will be focusing our efforts on the ability
to continue to accept ICD-9 codes, and will
monitor developments and provide additional
updates regarding our ICD-10 implementation
plans as needed.
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CIGNA NETWORK NEWS
•
OCTOBER 2014
Get paid faster
Stop waiting for checks to clear, shorten your payment cycle, and help improve
your office workflow productivity. You can do all this by enrolling in electronic
funds transfer (EFT) with Cigna. Also known as direct deposit, EFT electronically
deposits fee-for-service and capitated payments directly into your bank account.
When used together, EFT and electronic remittance advice (ERA) can help
eliminate claims payment paperwork and improve your cash flow. We provide
EFT for our PPO, OAP, HMO, Cigna Global Health Benefits, and Arizona Medicare
Advantage HMO claim reimbursements.*
Two options to enroll in EFT
› Option 1: Enroll in EFT with multiple payers, including Cigna, using the
Council for Affordable Quality Health Care (CAQH) website
› Option 2: Enroll in EFT directly with Cigna by logging in to CignaforHCP.com
> Working with Cigna > Enroll in Electronic Funds Transfer (EFT) Options
Two options to bulk your EFT payments
› Option 1: By your Taxpayer Identification Number (TIN) and
payment address
› Option 2: By your Billing Provider National Provider Identifier (NPI)
from your submitted claims
If you already receive EFT payments and wish to change the method by which
your payments are bulked, log in to CignaforHCP.com > Working with Cigna >
Manage EFT Settings, and update your payment preferences from this page.
Easily access remittance reports the same day you receive your electronic
payments
If you are enrolled in EFT with Cigna, and are registered for CignaforHCP.com with
access to claims status inquiry, you can easily access your remittance reports for
your payments.
› Log in to CignaforHCP.com > Remittance Reports
› Search for your remittance reports by deposit amount, patient information,
or claim/reference number
Not registered for the website?
› Go to CignaforHCP.com and click “Register Now”
› For step-by-step registration directions, click “Learn how to register”
Electronic remittance advice
With electronic remittance advice (ERA), your remittance information can be
automatically loaded into your accounts receivable system. This can:
› Reduce costs and save time
› Reduce posting errors
› Shorten the payment cycle
Enroll through your EDI vendor or Post-n-Track® at Post-n-Track.com/Cigna.
* EFT payments are not currently available for claim reimbursements for patients with GWH-Cigna or “G” ID cards.
H EALTH CARE RE FO RM N EWS
Cigna’s proprietary retail exchange launches nationally
On August 14, 2014, Cigna (NYSE:CI) launched its proprietary
private retail exchange in new markets and expanded it in others,
offering employers a new, cost-effective way to give employees
more benefit choices, all in one place.
Cigna’s private retail exchange became available to Cigna clients
and prospective clients across all of Cigna’s U.S. markets on
September 1. The suite of products available through the private
exchange includes a variety of medical, pharmacy, dental, vision,
life and accident, and disability plans.
According to a recent national survey of 723 employers
conducted by the Private Exchange Evaluation Collaborative
(PEEC), 45 percent said they plan to consider or will be using
a private exchange for their full-time active employees before
2018. The survey also indicated that employers are seeking
comprehensive capabilities and services from private exchanges;
and close to 70 percent of employers believe it is very important
that their advisor is independent of any exchange they are
considering.
“Cigna’s goal is to offer a full range of plan choices to employers
and employees and their families as they become more actively
involved in their health and benefit choices,” said Dave Guilmette,
president, Global Employer and Private Exchanges. “There is a
growing interest among employers in private exchange options,
and Cigna is meeting this marketplace need.”
With Cigna’s new offering, employees can access user-friendly,
online, interactive shopping tools to get a personalized
recommendation for benefits for themselves and their families.
For employers, the exchange offers a benefits administration
platform that can enable them to provide employees with more
choice of plan designs and define contribution funding, while
simplifying their administrative responsibilities and helping them
control their benefit costs.
Cigna’s private exchange includes 24-hour live customer service
for medical and dental customers, Cigna’s broad network of
physicians and hospitals and integrated health and wellness
programs, and is available with both fully insured and self-funded
health benefit plans.
In addition to this proprietary solution, called Cigna Guided
Solutions, Cigna is actively participating in a number of private
exchanges administered by benefit consultants and brokerage
firms that target active employees and retirees. Cigna also offers
Benefits Insight® through its Choicelinx® subsidiary, providing
employers and brokers with customized online enrollment,
decision support, and benefits administration services.
CIGNA NETWORK NEWS
•
OCTOBER 2014
7
GEN E RA L N E WS
Shared administration program
and tobacco cessation
Cigna provides health benefit services to more than 1.5 million people covered
by Taft-Hartley and Federal Employee Health Benefit (FEHB) plans as part of
our shared administration program. For these relationships, we provide access
to the Cigna network, perform medical management and utilization review,
reprice claims according to our contracted rates and claims logic, provide
contract dispute resolution, and may offer clinical appeals management or other
outpatient care management.
FEHB plans within the shared administration product offer their own tobacco
cessation programs to their members at no cost. These plans include:
› American Postal Workers Union (APWU)
› National Association of Letter Carriers (NALC)
› SAMBA Federal Employee Benefit Association
If you have Cigna patients who have coverage through an FEHB plan* and may
benefit from a tobacco cessation program, please refer them to their employee
health benefit plan for details on how to enroll. This is an important initiative for
the federal government and their employees.
TOPIC
CONTACT
Contract pricing inquiries
and claim pricing status
1.800.549.8908 (representatives are available
between the hours of 8:00 am and 6:00 pm EST)
Paper and electronic claim
submission addresses
Cigna Payer ID: 62308
PO Box 188004, Chattanooga, TN 37422-8004
Authorizations and
precertifications
Telephone number or address on the
patient’s ID card
• Eligibility
• Benefits
• Claim payment status
Third-party administrator (TPA) telephone
number or address on the patient’s ID card
* Your patient has coverage through a FEHB plan if the acronym APWU, NALC, or SAMBA appears on the ID card.
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CIGNA NETWORK NEWS
•
OCTOBER 2014
Additional information
To learn more about shared
administration benefits, visit the Cigna
for Health Care Professionals website
(CignaforHCP.com > Resources > Medical
Resources > Medical Plans and Products >
Shared Administration).
You can also refer to the contact
information for help with specific topics
related to shared administration plans.
Improved health care
professional directory
Our new health care professional directory delivers
faster and more direct search results at Cigna.com.
We’ve simplified the search for doctors, dentists and
hospitals at Cigna.com with a new and more engaging
experience on Cigna.com and CignaforHCP.com. You’ll
find it easier to find in-network referrals for your patients.
Plus, you and your patients will enjoy:
Better navigation with
a new look and feel
An intuitive search that spell
corrects and fills in the blanks
with smart suggestions
arranged by subject
Information to help you easily
refine your search results by
distance, years of service, quality
designations, gender, and more
Separate search paths for
dentists vs. doctors
With our all-new directory, we’ve made it easier than ever
to find the right health care professional.
Updating your information
If you need to update your information that appears in the
directory, submit changes electronically using the online
form available on the Cigna for Health Care Professionals
website at CignaforHCP.com. After you log in, select
Working with Cigna on your dashboard, and then choose
the appropriate link for an individual or group health care
professional. You will be directed to the online form to
complete and submit.
Help keep medical costs
down by referring Cigna
customers in network
Referring in network can keep your patients –
and their wallets – healthy
As a trusted health care professional, you play an important role
in helping your patients make more informed choices about their
health, the services they receive, and how they spend their health
care dollars. With health care costs continuing to rise, it’s more
important than ever to be conscious of how much your patients
are paying for the care they receive.
By making referrals to participating health care professionals and
facilities, you can help your patients make more informed choices
about how they spend their health care dollars.
By staying in network, your patients will…
› Receive the greatest value from their medical benefits
› Minimize out-of-pocket expenses
› Ensure that they have convenient access to quality services
Keep in mind that your patient will be responsible for any out-ofnetwork charges according to their benefit level when you make
a referral to a non-participating health care professional. These
costs can be considerable, especially for patients who do not
have out-of-network benefits.
Did you know?
Your patients can save up to 75% on the cost of covered
laboratory services if they stay in network?
That’s why we, along with your patients, appreciate your
efforts to help keep medical costs down by making referrals
to participating health care professionals and facilities.
Make in-network referrals
To find a current list of participating health care professionals
and facilities, please review our online health care professional
directory (CignaforHCP.com > Cigna Health Care Professionals
Directory) or call us at 1.800.88.Cigna (882.4462).
Questions?
Call Cigna Customer Service at 1.800.88Cigna (882.4462).
CIGNA NETWORK NEWS
•
OCTOBER 2014
9
GEN E RA L N E WS
Cigna Care
designation 101
Cigna Care designation is how we identify Cignaparticipating physicians and physician groups in 71
markets across 21 specialties, including primary care,
that meet Cigna’s quality and cost-efficiency measures.
The Cigna Care designation is provided to individual
physicians and physician groups based on an evaluation of
cost (Cigna claim data) and quality data. Those physicians
who are in the highest group for their results on Cigna’s
quality measures, and who also have the most costefficient group results as compared to their peers in their
market, receive a Cigna Care designation. Additionally,
physicians and physician groups that participate in a Cigna
Collaborative Accountable Care (CAC) arrangement, and
meet certain quality and cost thresholds, can be eligible
to receive the Cigna Care designation.
Methodology
To learn more about the methodology we use to
determine Cigna Care designation, and physician quality
and cost efficiency displays, please review our white paper
at Cigna.com/CignaCareDesignation. If you do not have
Internet access, please call Cigna Customer Service at
1.800.88Cigna (882.4462) to request a copy.
Additional information
Because Cigna Care designation is provided to individual
physicians and physician groups based on an evaluation of
cost and quality data, it is important that our information
accurately reflects your practice dynamics. Periodically,
a representative from Cigna may contact your practice
to request a current list of the physicians participating
in your group. We use this information to validate that
your practice and physician information is correct in
our systems. It is also used to ensure the symbols for
physicians and physician groups that have received a
Cigna Care designation, as well as those that have been
assigned quality and cost-efficiency displays, are correctly
identified in the Cigna online health care professional
directory at Cigna.com and myCigna.com.
We welcome your feedback
Cigna ID card changes
Starting in November 2014, some Cigna ID cards will be
changing. When issued for new or renewing plans, those that
currently include “GWH-Cigna” will instead show a “G” on the
front of the card.
“GWH-Cigna” or “G” appears on ID cards to identify separate
service channels. While the network is now the same as the
standard Cigna network, we recognize that you need to be able
to identify customers in these plans because of some differences
in how you perform administrative transactions on their behalf,
such as:
› Checking benefits – Check benefits and eligibility on
the secure Cigna for Health Care Professionals website
(CignaforHCP.com) or through the Electronic Data
Interchange (EDI) 270 transaction process
› Precertifying services – The precertification tool on the
Cigna for Health Care Professionals website will redirect to
the appropriate service channel
› Receiving electronic and paper claim payments –
Payments may be issued at different times from other
Cigna payments you may receive
The Cigna for Health Care Professionals website and electronic
transaction responses will continue to indicate “GWH.”
As always, continue to refer to the important information
on the ID card for call and claim information, and the plan’s
precertification requirements. For additional information, refer to
the ID card brochure on the Cigna for Health Care Professionals
website (CignaforHCP.com > Resources > Medical Resources >
Doing Business with Cigna > Cigna ID Card Information).
CARD FRONT
We are committed to working with our health care
professionals to continue improving the reliability of
our quality and cost efficiency measures. We value our
relationship with you, and welcome your feedback to
further enhance and refine our program.
CARD BACK
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CIGNA NETWORK NEWS
•
OCTOBER 2014
Cigna Centers of Excellence
Based on Cigna claims data, we evaluate hospital
patient outcomes (quality) and cost-efficiency
information through the Cigna Centers of
Excellence (COE) program. Participating hospitals
meeting specific quality and cost-efficiency criteria
are designated Centers of Excellence by procedure
and condition.
Profiles are available to patients with Cigna
coverage for most hospitals participating in the
Cigna network.
About the hospital profile
Additional information
To learn more about the methodology we use to
determine COE designation, please review our
white paper at Cigna.com/CentersofExcellence. If
you do not have Internet access, please call Cigna
Customer Service at 1.800.88Cigna (882.4462).
Timeline for Centers of Excellence
designations and displays:
September 18, 2014
› A score of up to three stars (*) each for
Hospitals were sent a notification
about the availability of their
2015 results.
› Hospitals that attain at least five stars
January 1, 2015
both patient outcomes and cost-efficiency
measures can be received for each procedure
and condition evaluated.
(three stars for patient outcomes and two
stars for cost efficiency or three stars for
cost efficiency and two stars for patient
outcomes) receive the Cigna Center of
Excellence designation for that surgical
procedure or medical condition.
› Hospital data may not display in the online
provider directory if:
› There is insufficient patient volume or
All Payor or MedPar data available for
that procedure or condition
› A surgical procedure is not performed or
a condition is not treated at the hospital
› A contract limitation prohibits display of
cost and quality data
COE information will be available in
the health care professional directory
on Cigna.com and myCigna.com.
The Cigna COE program is designed to meet
the ever-growing customer demand for tools
and information on patient outcomes and cost
efficiency. Because the COE program reflects only
a partial assessment of quality and cost efficiency
for select hospitals, it should not be the sole factor
used when making decisions. We encourage
individuals to consider all relevant factors, and to
speak with their treating physician when selecting
a hospital.
CIGNA NETWORK NEWS
•
OCTOBER 2014
11
GEN E RA L N E WS
Important reminder: Missouri claim
mailroom closed July 1, 2014
On July 1, 2014, we consolidated all mailing locations for Cigna paper claims and appeals
to Chattanooga, TN. The Kennett, MO mailing addresses that you previously may have
used are no longer in service. Claims and appeals mailed to Kennett will be forwarded to
Chattanooga by the U.S. Postal Service.
Cigna ID cards and other communication may continue to display the Kennett, MO address
until new ID cards are issued and material is updated. Please send all paper claims to the
appropriate Chattanooga PO Box as indicated below.
FUNCTION
FORMER (CLOSED)
ADDRESS
NEW ADDRESS
General mail (including
Payor Solutions)
1000 Great-West Drive
Kennett, MO 63857-3749
PO Box 188061
Chattanooga, TN 37422-8061
GWH-Cigna appeals
PO Box 668
Kennett, MO 63857-0668
PO Box 188062
Chattanooga, TN 37422-8062
Cigna LifeSOURCE
Transplant Network®
PO Box 228
Kennett, MO 63857-0228
PO Box 188063
Chattanooga, TN 37422-8063
GWH-Cigna Behavioral
Health appeals
PO Box 763
Kennett, MO 63857-0763
PO Box 23487
Chattanooga, TN 37422-3487
Health care
professional
agreements – final
phase of contract
entity change
To create a consistent brand across
our legal entities and affiliates, we are
completing the final phase of assigning
all health care professional and facility
participation agreements to Cigna Health
and Life Insurance Company (CHLIC). This
assignment does not affect the current
terms, rates, or reimbursements associated
with your agreement.
If you have any questions, please
call Cigna Customer Service at
1.800.88Cigna (882.4462).
12
CIGNA NETWORK NEWS
•
Electronic claim submission
As a reminder, you may still submit
claims electronically. For more
information about electronic claim
submission, please go to the Cigna
for Health Care Professionals website
(CignaforHCP.com > Resources >
Reimbursement and Payment Policies >
Claim Policies and Procedures >
How to File).
ID cards
We will update ID cards with the new
Chattanooga claim address as plans
renew. It is anticipated that ID card
reissuance will take approximately
18 months. Other Cigna documents
and communications referencing the
Kennett address will also be updated.
For more information
If you have questions, please
call Cigna Customer Service at
1.800.88Cigna (882.4462).
National Committee for Quality
Assurance updates quality
measure for Controlling High
Blood Pressure
In July of 2014, the National Committee for Quality Assurance (NCQA) updated
a Healthcare Effectiveness Data and Information Set (HEDIS®) metric for
Controlling High Blood Pressure to align with recommendations made by The
American College of Cardiology and American Heart Association. New blood
pressure guidelines are effective for the 2015 measurement year.
NCQA added age- and condition-specific treatment goals that align with the
eighth Joint National Committee hypertension guidelines:
› 18–59 years (<140/90 mm Hg)
› 60–85 years with diabetes (<140/90 mm Hg)
› 60–85 years without diabetes (<150/90 mm Hg)
For more information on the NCQA’s quality measures, please visit ncqa.org.
OCTOBER 2014
LocalPlus network
expanding to new markets
LocalPlus®, a product suite that has been introduced in several
states and markets, can provide our customers with access to a
smaller network of quality health care professionals, hospitals,
and ancillary providers at a lower cost than other traditional plans.
In keeping with the evolving needs of our customers, we will
expand the reach of the LocalPlus network, beginning
October 1, 2014, to include a new market:
› Bryan/College Station Area (Houston, TX) (previously
available only for individual family plans)
We will also expand the reach of the LocalPlus network,
beginning January 1, 2015, to include these new markets:
› Massachusetts for employer business
› Rhode Island for employer business.
› Phoenix, Arizona for employer business (previously
available only in the individual market)
› Georgia
› Employer and individual and family plan business
in Atlanta, Augusta, Columbus, Macon, Rome, and
Savannah
› Individual and Family plans in Atlanta, Macon,
and Rome
LocalPlus plans offer coverage for the full scope of services
provided by traditional Cigna-administered plans within a smaller
network of participating health care professionals. The LocalPlus
product suite includes the following four plans:
› LocalPlus
› LocalPlus IN
› Choice Fund LocalPlus
› Choice Fund LocalPlus IN
The key difference between LocalPlus and LocalPlus IN plans is in the
customer’s access to the network and the benefit coverage level.
Making referrals
You can access the Cigna.com online directory to find
participating LocalPlus health care professionals, hospitals, and
ancillary providers. These listings will be in the online directory
beginning October 1, 2014, and will be noted within the network
selection by “LocalPlus.”
Beginning January 2015, patients with LocalPlus plans may
present a new ID card. Similar to standard Cigna ID cards, the new
card will indicate LocalPlus, LocalPlus IN, Choice Fund LocalPlus,
or Choice Fund LocalPlus IN as the network name. The LocalPlus
ID card will also contain information about customer service
contacts, benefits, and where to submit claims.
Additional information
For more information or questions, you can call Cigna Customer
Service at 1.800.88Cigna (882.4462) or log into CignaforHCP.com
Helping your patients save on radiology services
We strive to provide our customers with access to cost-effective,
quality services. As a trusted health care professional, you play
an important role in helping us fulfill that commitment. Through
referrals, you can help your patients make more informed choices
about their health, the services they receive, and how they spend
their health care dollars.
For instance, did you know that costs for radiology services can
vary greatly, depending on where the service is provided? On
average, high-technology radiology services like MRI, CT, and
PET scans provided by an independent radiology center are
about $1,000 less than the same scan provided in the outpatient
radiology department of a hospital.* That’s why we provide
our customers with access to a network of more than 3,000
independent radiology locations nationwide where they can
receive services at competitive rates.
As a reminder, individuals should always be encouraged to select
a facility that is conveniently located and offers the lowest cost.
In fact, your patients with Cigna-administered coverage may
already be familiar with our Informed Choice program, which
may proactively provide them with these cost comparisons so
they can choose the most convenient and cost-effective facility
for having their MRI, CT, or PET scan.
For the most current list of network facilities, please visit our
website at Cigna.com, click “Find a Doctor,” then search for
“Radiology & Imaging Services” under “Find a Place By type.” And
don’t forget to put in your patient’s ZIP code to find facilities close
to them.
If you would like additional information about the benefits of
referring your patients with Cigna-administered coverage to
these cost-effective facilities, please call Cigna Customer Service
at 1.800.88Cigna (882.4462). If you would like more information
about our Informed Choice program, please visit Cigna.com/
InformedChoice.
* Based on Cigna’s average cost difference of independent radiology centers versus outpatient radiology
departments.
CIGNA NETWORK NEWS
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OCTOBER 2014
13
MED IC ARE N E WS
Tips to avoid administrative
claim denials
In an effort to prevent unnecessary administrative claim denials,
Cigna Medicare Services has compiled a list of top reasons for
administrative claim denials and how to avoid them.
DENIAL REASON
HELPFUL TIP
No authorization
Know which services require
preauthorization and obtain it prior to
providing service. Also know when the
authorization expires and obtain a new
one for ongoing services.
Invalid or missing
modifier
Ensure that the modifier attached to a
service is appropriate for that service.
If a modifier is required, be sure that it
is billed.
Primary carrier
explanation of
benefits (EOB)
required
Identify patients who have dual
coverage and ensure your office is
billing the primary carrier first and
attaching their EOB when billing the
secondary carrier.
Untimely filing
Know your contracted timely filing
guidelines. When filing electronically,
check the electronic summary reports
to make sure the claim was accepted.
Also, review the rejection reports, make
any necessary corrections and resubmit
immediately. When filing by paper,
ensure you have the correct claim
address for Cigna Medicare claims,
which is noted on the patient’s Cigna
ID card.
In addition to these tips for avoiding these specific denials, please
also be aware of what services Medicare covers. Cigna Medicare
Services will not cover services that Medicare does not cover,
except in certain situations where Cigna has added the service as
an additional benefit. Lastly, be sure to list the referring physician
when applicable, as this can also help streamline
claims processing.
Cigna Medicare
Advantage Plan earns
high CMS star ratings
Every year the Centers for Medicare & Medicaid Services
(CMS) rates Medicare Advantage Plans on a scale of one
to five stars – five being the highest level of recognition.
Performance is measured in several areas including:
Preventive care, chronic disease management, and
customer service.
Cigna HealthCare of Arizona’s Medicare Advantage Plan has
achieved a 4.5-star out of five-star rating for the last three
consecutive years by CMS. In fact, no other health plan in
Arizona rates higher than Cigna.
The rating system
The CMS five-star rating system measures clinical quality
and performance benchmarks for Medicare Advantage
Plans based on more than 50 performance measures that
are collected through three surveys: HEDIS® (Healthcare
Effectiveness Data and Information Set), CAHPS (Consumer
Assessment of Healthcare Providers and Systems) and HOS
(Health Outcomes Survey).
In addition to enhanced revenue from CMS, a five-star rating
allows a plan to enroll beneficiaries year-round rather than
just during the annual enrollment period – a window from
mid-October to early December.
How physicians help increase ratings
Physicians play an important role when it comes to a health
plan’s star rating because measurements are based on
anonymous surveys mailed by CMS that ask customers to
assess certain plan functions, operations and care. Current
customers are asked things like “How often did you get care
as soon as you needed it?”“How often were plan forms easy
to understand?” and “Have you ever had a pneumonia shot?”
In addition, some HEDIS performance measures include:
advising smokers to quit, controlling high blood pressure,
and breast cancer screening. Physicians can help to
increase star ratings by helping patients to stay healthy
with preventive screenings, tests, and vaccines. In addition,
physicians can help to manage patients with chronic
conditions by making sure patients have specific tests and
treatments to help manage their condition.
To learn more about the CMS five-star rating system, please
visit cms.gov or medicare.gov.
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CIGNA NETWORK NEWS
•
OCTOBER 2014
P H ARM ACY N EWS
Preferred hyaluronates
added to Cigna drug list
To help promote the use of cost-effective drugs for our customers
and clients, we’ve added the following four drugs to the
hyaluronate category of preferred brands on the Cigna drug list:
MONOVISC®
Orthovisc®
SYNVISC®
Synvisc-One®
Hyaluronates are specialty drugs used for the treatment of knee
pain associated with osteoarthritis in patients who have not
responded to conservative pain medications. They are injected
into the knee by a health care professional as a series of one to
five injections. (The number depends on the drug used).
Precertification required for hyaluronates
All of the following hyaluronate drugs, including the preferred
brands, require precertification:
J7323 Euflexxa®
J7326 Gel-One®
J3490 MONOVISC
J7324 Orthovisc
J7321 SUPARTZ®/HYALGAN®
J7325 SYNVISC/Synvisc-One
Obtaining precertification for specialty drugs
When you order specialty pharmacy drugs through Cigna
Home Delivery Pharmacy, we’ll help manage the precertification
process, coordinate prescription refills and renewals, and help
ensure your patients are getting the support they need for their
complex conditions. For more information, or to order and obtain
precertification for a specialty drug, call Cigna Specialty Pharmacy
Services at 1.800.351.3606. Order forms are available on the
Cigna for Health Care Professionals website (CignaforHCP.com).
Coverage of breast
cancer prevention drugs
The Patient Protection and Affordable Care Act (PPACA)
requires non-grandfathered health plans to cover, as a
preventive service with no cost sharing, medications that
reduce the risk of breast cancer for women who are at an
increased risk of breast cancer. This change is effective for
new and renewing customers with plan years beginning
on and after September 24, 2014.
Cigna Pharmacy plans will cover tamoxifen and raloxifene for
women with no cost sharing or prior authorization required.
For more information about PPACA, refer to Cigna’s Informed
on Reform website (Cigna.com > Informed on Reform).
CIGNA NETWORK NEWS
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OCTOBER 2014
15
CONNE C TE D C A R E
Cigna and Samsung
score with new
“Coach by Cigna” app
How it can help your patients
Cigna and Samsung Electronics Co. Ltd. have teamed up to
deliver the next generation of smart health coaching services.
Coach by Cigna, a digital health guidance tool unveiled to nearly
200 million Galaxy S® 5 users last May, will soon be available in 36
countries and 26 languages.
Individuals answer a few lifestyle questions and Coach by Cigna
will help craft a lifestyle improvement plan involving exercise,
nutrition, sleep, stress, and weight. The app provides full access
to built-in, native features, such as activity tracking, step counter,
nutrition and meal tracking, sleep monitoring, and calories
consumed and burned.
Built on the experiences of Cigna’s own health coaches,
nutritionists, behavioral specialists, and nurses, Coach by Cigna,
which is integrated within the S Health App system, is focused on
making health and well-being a fun, interesting, and vital part of
everyday life.
Universal availability
While Cigna is providing the content, experience, and engines for
valuable health insights for the app, it is available to all Samsung
Galaxy S® 5 users worldwide. Because Coach by Cigna is available
to everyone – not just your patients with Cigna-administered
coverage – we’ve dramatically increased the number of people
we – along with health care professionals – can reach to help
them improve their health, well-being, and sense of security.
Want to see how it works?
16
CIGNA NETWORK NEWS
•
OCTOBER 2014
S Health is a Samsung platform initiative that collects and
integrates health information from smartphones and new
Samsung Galaxy Gear devices – all with easy-to-use features in a
mobile dashboard.
Users can personalize their health goals and tackle related
missions that can be measured and scored using S Health App’s
real-time fitness tracking data. Progress is supported by Coach by
Cigna motivational messaging, quantifiable health assessments,
and achievement badges that help individuals record their own
personal best in life.
Coach by Cigna resonates with today’s modern exercise practices
and behaviors because it focuses on establishing habits that help
individuals manage key factors that contribute to health issues,
including diabetes and high blood pressure.
How to download
Coach by Cigna comes preinstalled on the new Galaxy S® 5
smartphone and The S Health App is preloaded on the phone
under the apps tile. For first time users, Coach by Cigna is made
available through the S Health App auto-update.
Cigna programs and
technology driving
health & wellness
Talk to your patients about the 24-hour
Health Information Line
Health needs don’t always follow regular business hours. But
with Cigna’s Health Information Line, your patients always
have easy access to helpful information and support. Nurses
are available 24 hours a day, seven days a week, providing
convenient, confidential services such as:
Helping patients understand and make informed decisions about symptom-based health issues they are
experiencing when they call.
Allowing patients to choose the right care in the right setting at the right time, whether it’s going to the nearest
emergency room or urgent care center, following up on a doctor’s appointment, reviewing home treatment
options or directing them to call 911.
Offering patients a wide variety of health and medical information, including access to an audio health library.
Introducing patients to a variety of online tools to help them become more engaged in their own health care.
Referring patients to other health care professionals or programs that could be available with their health plan,
including case management and chronic condition support health advocacy programs.
Helping patients reach our Health Information Line is easy. Just tell them to call 800.Cigna24 or the
toll-free number on their Cigna ID card.
CIGNA NETWORK NEWS
•
OCTOBER 2014
17
REGI ONA L N E WS
New York and Texas –
Out-of-network disclosure forms
Except in the case of an emergency, when a referral is needed,
patients with Cigna-administered coverage generally expect and
prefer that their Cigna participating physician refer them to other
participating physicians so they may use their in-network benefits
whenever possible. Please be aware that an out-of-network
disclosure form must be completed by the referring physician (and
not delegated) each time a referral is made to a non-participating
health care professional or facilities, including ambulatory surgical
centers, dialysis facilities, and freestanding laboratories.
How to access and use the forms
Cigna customers should have the necessary information to
make an informed decision regarding the use of participating or
non-participating health care professionals or facilities, such as:
Please note: It is not necessary to complete the form in
emergency situations, or if Cigna determines there is no
alternative Cigna-participating health care professional
that can provide the requested covered services. A copy of
the completed form should be given to the patient and the
original placed in the patient’s medical file. Please note that
the use of this form is subject to periodic audits to ensure
compliance with this administrative requirement.
› The potential financial impact of their choices
› In-network alternatives
› The referring physician’s financial interest, if a non-
participating health care professional is chosen
When you refer a Cigna customer to a non-participating health
care professional, facility or other health care entity, they will
be responsible for the out-of-network charges consistent with
their benefit plan. A complete list of participating health care
professionals, facilities, and other health care entities can be found
on our websites at Cigna.com and CignaforHCP.com.
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CIGNA NETWORK NEWS
•
OCTOBER 2014
The New York and Texas out-of-network disclosure forms are
located here:
› New York Patient Notice and Disclosure Form for referral
to a non-participating Health Care Professional, facility
or vendor
› Cigna Out-of-Network Disclosure Form for Health
Care Professionals in Texas
Additional information
Criteria for our out-of-network referral policies were derived
from published materials that are supported by nationally
recognized agencies such as the American College of Medical
Quality (ACMQ). For more information regarding the ACMQ,
visit their website at http://www.acmq.org.
H E LP FUL REMI N DER S
Market Medical Executives contact information
Cigna Market Medical Executives (MMEs) are an important part of our relationship with health care professionals. They provide
personalized service within their local regions and help answer your health care-related questions. MMEs cover specific geographic
areas so they are able to understand the local community nuances in health care delivery. This allows them to provide you with a
unique level of support and service.
National
Nicholas Gettas, MD, Chief Medical Officer, Cigna Regional Accounts
1.804.379.0645
Northeast region
Peter McCauley, Sr., MD, CPE
Regional Medical Director
IL, IN, MN, ND, SD, WI, MI
1.312.648.5131
Frank Brown, MD
DC, MD, VA
1.804.344.2384
Jack Davidson, MD, MBA
KS, MO, NE, IA, ND, SD
1.314.290.7313
Robert Hockmuth, MD
CT, MA, ME, NH, RI, VT
1.603.268.7567
Tiffany Lingenfelter-Pierce MD
Ronald Menzin, MD
CT, MA, ME, NH, RI, VT
1.603.203.4317
NJ, NY
NJ, NY
DE, OH, PA, WV
1.631.247.4526
1.646.658.7157
1.215.761.7168
• Ask questions and obtain general
information about our clinical
policies and programs.
1.314.610.0095
• Report or request assistance with
a quality concern involving your
patients with Cigna coverage.
E. David Perez, MD
Christina Stasiuk, DO
Southeast region
Jordan Ginsburg, MD
Regional Medical Director
Robert W. Hamilton, MD
AL, GA
1.404.443.8820
Michael Howell, MD, MBA, FACP
FL, USVI
1.407.833.3130
Edward Hunsinger, MD
NC, SC
1.860.902.6671
Renee McLaughlin, MD
AR, KY, MS, TN
1.423.763.6764
Mark J. Netoskie, MD, MBA, FAAP
LA, South TX
1.713.576.4465
Frederick Watson, DO, MBA, CPE
North TX, OK
1.972.863.5119
Jennifer Gutzmore, MD
Regional Medical Director
Southern CA
1.818.500.6459
Jacob Asher, MD
Northern CA
1.415.317.1613
John Keats, MD
AZ, NV
1.480.426.6779
Mark Laitos, MD
CO, NM, UT, WY
1.303.566.4705
John Sobeck, MD
AK, HI, ID, MT, OR, WA
1.206.625.8861
West region
Reference guides
Cigna Reference Guides for participating physicians, hospitals,
ancillaries, and other health care professionals contain many of
our administrative guidelines and program requirements. The
reference guides include information pertaining to participants
with Cigna and GWH-Cigna ID cards.
Reasons to call
your MME
• Ask questions about your specific
practice and utilization patterns.
• Request or discuss
recommendations for
improvements or development of
our health advocacy, affordability,
or cost-transparency programs.
• Recommend specific physicians
or facilities for inclusion in our
networks, or identify clinical
needs within the networks.
• Identify opportunities to enroll
your patients in Cigna health
advocacy programs.
Access the guides
You can access the reference guides by logging in to
CignaforHCP.com > Resources > Reference Guides > Medical
Reference Guides > Health Care Professional Reference Guides.
You must be a registered user to access this site. If you are not
registered for the website, click on “Register Now.” If you prefer
to receive a paper copy or CD-ROM, call 1.877.581.8912 to
request one.
CIGNA NETWORK NEWS
•
OCTOBER 2014
19
HEL PFUL RE M I N D E R S
Go green — go electronic
Would you like to reduce paper in your office? Sign up now to
receive certain announcements and important information from us
right in your email box. When you register for the secure Cigna for
Health Care Professionals website, CignaforHCP.com, you can:
› Share, print, and save – electronic communications make
it easy to circulate copies
› Access information anytime, anywhere – view the latest
updates and time-sensitive information online when
you need to
When you register, you will receive some correspondence
electronically, such as Network News, while certain other
communications will still be sent by regular mail.
If you are a registered user, please check the “My Profile” page to
make sure your information is current. If you are not a registered
user, but would like to begin using the website and receive electronic
updates, go to CignaforHCP.com and click “Register Now.”
Urgent care for non-emergencies
People often visit emergency rooms for non-life-threatening
situations, even though they usually pay more and wait longer.
Why? Because they often don’t know where else to go.
You can give your patients other options. Consider providing
them with same-day appointments when it’s an urgent problem.
And, when your office is closed, consider directing them to a
participating urgent care center, rather than the emergency
room, when appropriate.
For a list of Cigna’s participating urgent care centers, view our
Health Care Professionals Directory at Cigna.com > Health Care
Professionals > Resources > Find a Doctor.
Cultural competency training and resources
As the population in the United States continues to diversify,
it’s important to obtain a better understanding of culturally
driven health care preferences. Cultural competency resources
are available to health care professionals on the Cigna.com and
CignaforHCP.com websites. Please check the websites often
for newly added training and resources, which are available at
no extra cost to you.
What’s new
› Health literacy – learn more about health literacy
through engaging case studies, valuable toolkits,
patient safety monographs, patient tip cards, and more.
› Guidelines for Care of Lesbian, Gay, Bisexual, and
Transgender Patients – Review these guidelines to
understand health care disparities that may affect
lesbian, gay, bisexual, and transgender (LGBT)
populations. Learn how you can help create a
welcoming environment for these patients.
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CIGNA NETWORK NEWS
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OCTOBER 2014
As a reminder, you will be able to access existing links to
resources including CultureVisionTM, a comprehensive online
resource to gain insights and understanding on patient care for
more than 50 cultural communities. Also available is a toolkit
to help you and your staff screen for cultural needs of a diverse
patient practice – better communication, better care: Tools to
care for diverse populations. More resources such as articles,
training, videos, a cultural competency assessment, and tips on
working with a language interpreter are also available.
Go to either of these websites to learn more:
Cigna.com > Health Care Professionals > Resources for Health
Care Professionals > Health & Wellness Programs > Cultural
Competency Training and Resources
CignaforHCP.com > Resources > Medical Resources >
Doing Business with Cigna > Cultural Competency
Training and Resources
Have you moved recently?
Did your phone number change?
Check your listing in the Cigna directory
If you are located in:
We want to be sure that Cigna customers have the right information
they need to reach you when seeking medical care. Please check your
listing in our health care professional directory, including your office
address, telephone number, and specialty. Go to Cigna.com >
Health Care Professionals > Health Care Professionals Directory.
AL, AR, DC, FL, GA, KY, LA, MD, MS, NC, OK, PR, SC, TN, TX,
USVI, or VA
Email: [email protected]
Fax: 1.888.208.7159
Mail: Cigna PDM, 2701 North Rocky Pointe Dr., Suite 800,
Tampa, FL 33607
If your information is not accurate or has changed, it’s important to
notify us – it’s easy. Submit changes electronically using the online
form available on the Cigna for Health Care Professionals website at
CignaforHCP.com. After you log in, select Working with Cigna on your
dashboard, and then choose the appropriate link for an individual or
group health care professional. You will be directed to the online form
to complete and submit. You may also submit your changes by email,
fax, or mail as noted below.
Please note that as part of our ongoing effort to help ensure accurate
information is displayed in the directory, we may call you in the
coming months to verify your information. We’ll take just a few
minutes of your time to validate information with you over the phone.
CT, DE, IL, IN, MA, ME, MI, MN, NH, NJ, NY, OH, PA, RI,
VT, WI, or WV
Email: [email protected]
Fax: 1.877.358.4301
Mail: Two College Park Dr., Hooksett, NH 03106
AK, AZ, CA, CO, KS, MO, NV, OR, UT, WA, or WY
Email: [email protected]
Fax: 1.860.687.7336
Mail: 400 North Brand Blvd., Suite 300, Glendale, CA 91203
Access the archives
To access articles from previous issues of Network News,
visit Cigna.com > Health Care Professionals > Newsletters.
Article topics are listed for each issue.
Letters to the editor
Thank you for reading Network News. We hope you find the articles
to be informative, useful, and timely, and that you’ve explored
our digital features that make it quick and easy to share and save
articles of interest.
Your comments or suggestions are always welcome.
Please email [email protected] or write to:
Cigna
Attn: Health Care Professional Communications
900 Cottage Grove Road, Routing B7NC
Hartford, CT 06152
“Cigna,” and the “Tree of Life” logo are registered service marks of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its operating subsidiaries. All products and services are provided by or through such operating
subsidiaries and not by Cigna Corporation. Such operating subsidiaries include Connecticut General Life Insurance Company, Cigna Health and Life Insurance Company, Cigna Behavioral Health, Inc., Cigna Health Management, Inc., and
HMO or service company subsidiaries of Cigna Health Corporation and Cigna Dental Health, Inc. All models are used for illustrative purposes only.
The term “health care professional” is referred to in contracts as “provider.” Use and distribution limited solely to authorized personnel.
878008 10/14 THN-2014-467 © 2014 Cigna. Some content provided under license.
CIGNA NETWORK NEWS
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OCTOBER 2014
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