Using these recommended billing guidelines and codes will help facilitate proper reimbursement and help to avoid errors and potential reimbursement delays. hTkSW?%yy$^5%VS&`Zc/JPZi(t45?lM.X Vb!1ZP&V8f[_2r}Iss/ 0S3UU%j9(UTT ( 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. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna. 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. Need help? 58 0 obj <> endobj endobj 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. If Medicare is the primary payer, timely filing is determined from the processing date indicated on the primary carrier's explanation of benefit (EOB). hb```, cb@1FFAA/j8Dcj29vPh Thank you for the quality care you provide to our members. 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 By using this site, you acknowledge that this material is copyrighted and agree to the terms and conditions noted above. 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 The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. All pictures are used for illustrative purposes only. PDF Cigna Medicare Advantage Plans Cigna Medicare Advantage Plans (Arizona 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. 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. Appeals and Disputes HIPAA Transaction Standards Questions? PDF QANI Reference Guide for physicians, hospitals, ancillaries, and other We are committed to ensuring that your participation in the QualCare network is a positive and beneficial experience. This website is not intended for residents of New Mexico. 6T O'@j8*r', ;#Na-16|=i8IO_K$ _v:s+)"{%#YdQA=2A`,?6P~<4?EE`GD*8j 5pg, =dn/G~5i/!,A1R5n12&A{@ &`" _X)Z$K:PQ84H&TiXh|eOJDK E@0Rkg,_c"3?KpmJT. Details, Applicable law requires a longer filing period, Provider agreement specifically allows for additional time, In Coordination of Benefits situations, timely filing is determined from the processing date indicated on the primary carrier's explanation of benefits (EOB) or explanation of payment (EOP). Cigna insurance, now, offers both PPO and HMO plans. wont be able to apply to eviCore openings. Details. Annual Utilization Statistics | Silver&Fit is a registered trademark of ASH and used with permission herein. CHCP - Resources - Durable medical equipment (including - Cigna If a resubmission is not a Cigna request, and is not being submitted as an appeal, the filing limit will apply. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna. Additional clinical guidelines may be developed as needed or may be withdrawn from use. However, the filing limit is extended another full year if the service was provided during the last three months of the calendar year. Cigna Medicare Advantage Plans . If you have any questions or would like more information about participating in a Cigna health care network, please contact us. Health Care Providers | Cigna If Medicare is the Secondary Payer (MSP), the initial claim must be submitted to the primary payer within Cigna's timely filing period. PDF IMPORTANT INFORMATION FROM CIGNA - Maryland.gov Enterprise Agency Template CHCP - Resources - Reimbursement Policies - Commercial - Cigna % All Rights Reserved. Message Here. *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * Provider Resources - hioscar.com In general, Medicare does not consider a situation where (a) Medicare processed a claim in accordance with the information on the claim form and consistent with the information in the Medicare's systems of records and; (b) a third party mistakenly paid primary when it alleges that Medicare should have been primary to constitute "good cause" to reopen. PDF Health Care Professionals Provider Manaul Medicare Advantage Encouraging patients to get vaccinated. Alere Home Monitoring, Inc. dba Acelis Connected Health Services: Hearing aids, replacement hearing aid batteries for non-rechargeable hearing aids, charging stations for rechargeable hearing aids, supplies, and personal sound amplification products, Fetal monitoring services, including use of electronic devices to check a babys heartbeat before and during childbirth, electronic fetal monitoring, fetal stress tests, and baby heartbeat monitors. Report Fraud & Abuse | ?siuC~62Ovxy:5igu+aF7c eviCore has a national network of providers who offer these services. 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. hbbd```b``kd d im "YC'`S`q{4.F wHeg`bdq m#@g l< 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. Cigna Billing Manual Form: Fillable, Printable & Blank PDF Form for
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