848810 network news nov11 v13 - cigna · radiology benefit and network management services cigna...

NetworkNews For Health Care Professionals

Participating in the Cigna and GWH - Cigna Networks

CONTENTS

Policy UpdatesClinical, reimbursement, and administrative policy updates 2MedSolutions, Inc. providing radiology benefi tand network management services 3Changes to claim submission timing 3

Integration newsClaimCheck 9.0 applied to GWH-Cigna claims 4One secure website coming soon 4

Electronic ToolsHIPAA 5010 updates 5Changes to improve your electronic experience 6Cost estimation capability now available for patients 6Tools for improving claim processing 7Electronic eligibility and benefi t informationthrough Emdeon for Cigna voluntary patients 7

Pharmacy newsNew hepatitis C therapy 8

general newsMarket Medical Executives contact update 9Cigna Centers of Excellence 9Weight management support for your patients 10Cultural competency training video now available 11Street address change for Cigna International 11Participate in the Leapfrog Hospital Survey 12Cigna Care designation, and quality andcost-effi ciency displays 12

helpful remindersCigna Medicare Access® private fee-for-servicecall center closed 13Reference guides updated 13Urgent care for non-emergencies 13Cigna debit card transactions 14Tell us what’s changed 14Use the network 14Shared benefi ts administration 15We’ve improved Network News 16Access the archives 16Go green – go electronic 16

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You may have noticed we have a new look – our logo, our colors, even the way we write our name are new – but it’s more than that! We’ve launched a new global brand with images and stories that are simple, but powerful: Cigna has the people and programs to work with you to help improve the health and well-being of every customer, so that they can enjoy a better life.

We recognize that everyone you treat is unique, and want to work with you to deliver personalized health support – support that can help you build stronger patient relationships, deliver better outcomes, and makes the job of delivering personalized care easier and more rewarding. Cigna can help support and nurture your patients’ unique strengths to help them achieve their full potential.

These are just some of the changes you may have seen or will notice in the coming months:Please note these changes will not occur all at once, but will happen over time. Existing ID cards and other materials are still valid.

• Our name. We are still Cigna, but now you’ll see that we are using both upper and lower case letters. Research with customers, clients and health care professionals tells us this is friendlier, easier

to read, and more customer-centric – a better representation of who we are and what we stand for.

• Our logo. We’ve changed our logo to refl ect our focus on our customers and our commitment to connect people with quality health care. You’ll still see reminders of our rich history in the tree motif, but we’ve added a human fi gure and fresh new color.

• ID cards. Starting in November 2011, we started issuing new ID cards for some of your patients with Cigna coverage. Initially, these new ID cards will not include the logo, but they will include the same information that appears on the cards today. Please continue to use the ID card for important information about call, claim, and service channels.

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“Cigna” on background

Cigna announces a change for the better

2 cigna network news • november 2011

Clinical, reimbursement, and administrativepolicy updatesIn an effort to help support access to quality, cost-effective care for your patients with a Cigna medical plan, we routinely review clinical, reimbursement and administrative policies, medical coverage positions, and our precertification process and requirements. The table below provides a summary of recent updates. You may also view new and updated policies, in their entirety, prior to the effective dates, on the Cigna for Health Care Professionals website (CignaforHCP.com). n

Policy Effective date Update Where to find additional information

Home uterine activity monitoring

July 15, 2011 Cigna no longer covers the use of tocolytic drugs for uterine activity monitoring in an outpatient or home setting

Cigna for Health Care Professionals website (CignaforHCP.com > Policies and Procedures> Coverage Positions/Criteria > Home Uterine Activity Monitoring)

Timely filing August 1, 2011 for AK, AR, AZ, CO, CT, DE, IL, IN, KS, LA, ME, MI, MO, NH, NY,* OH, OK, RI, SC, TX,** UT, VT, WI, WV November 1, 2011 for CA, GA, KY, MA, MS, NV, PA, TN,* WA

* NY and TN will have a 120-day claim filing limit.

** TX will have a 95-day claim filing limit.

Except as noted, the claim filing limit will change from 180 days to 90 days, for participating health care professionals who have received a notification and an amendment to their agreement in affected states (listed in the box to the left).

Cigna for Health Care Professionals website (CignaforHCP.com > Resources > Clinical Reimbursement Policies and Payment Policies > Claim Policies and Procedures > When to File

Urgent care October 17, 2011 for patients with a Cigna ID card

November 7, 2011 for patients with a GWH-Cigna ID card

Cigna no longer provides additional reimbursement for urgent care services for code S9088 [services provided in an urgent care center (list in addition to code for service)]

This code is considered incidental to the primary service(s) performed

Cigna for Health Care Professionals website (CignaforHCP.com> View ClaimCoding Edits > Professional Claims Code Editing and Documentation Requirements Guideline)

ClaimCheck for GWH-Cigna claims

November 7, 2011 Code editing software for GWH-Cigna claims will change to ClaimCheck® 9.0

Secured Provider Portal (GWHCignaforHCP.com > Clinical Edit Verification)

Modifier QK – medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals

November 7, 2011 Consistent with Cigna policies, GWH-Cigna claims with Modifier QK will be reimbursed at 50% of the fee schedule, to become consistent with Cigna policies

Cigna for Health Care Professionals website (CignaforHCP.com > Resources > Clinical Reimbursement Policies and Payment Policies > Modifiers and Reimbursement Policies)

Please noTe: You will need to complete the registration process to log in and access these policies if you are not registered for the Cigna for Health Care Professionals website. Go to CignaforHCP.com and click on Register Now, located in the left side bar. You can also access information on the Secured Provider Portal, GWHCignaforHCP.com. Cigna also applies its reimbursement and modifier policies to claims for your patients with GWH-Cigna ID cards. While the policies have been integrated, please follow the existing procedures for submitting claims.

POLIC Y UPDATES

cigna network news • november 2011 3

MedSolutions, Inc. providing radiology benefit and network management servicesCigna has entered into an expanded relationship with MedSolutions, Inc., who will now provide exclusive radiology benefit and network management services for Cigna, including the GWH-Cigna network. The transition began July 1, 2011 and has been occurring in phases. Health care professionals who are affected by this change will or have received a letter explaining this new relationship approximately 90 days prior to the transition date for their practice.

MedSolutions is a leading advanced radiology management company with a proven industry track record, dedication to quality, and dual national accreditation from the National Committee for Quality Assurance (NCQA) and the Utilization Review Accreditation Commission (URAC).

MedSolutions will provide the following services on behalf of Cigna:

• Radiology facility credentialing

• A utilization program featuring Predictive Radiology Intelligence

• Network management services

• Reimbursement of low-technology radiology services provided within the MedSolutions network

• Nuclear cardiology imaging management

Informed Choice support and outreach programWe are also featuring a support and outreach program called Informed Choice. The Informed Choice program is a decision support initiative designed to help patients learn the options available to them when selecting a radiology facility. This program will be introduced to Cigna customers prior to receiving MRI, CT, or PET services. For more information about these changes, please visit medsolutions.com/implementation. n

Changes to claim submission timing As a reminder, Cigna is changing the claim filing time limit from 180 days to 90 days for participating health care professionals, except where state law requires a longer time frame. These changes began August 2011 and will continue into 2012. Health care professionals are notified 90 days in advance of their effective date and receive an amendment to their agreement.

The first two phases began on August 1, 2011 and November 1, 2011, respectively. Only participating health care professionals who received a notification and amendment to their agreement from us, or who are newly contracted with Cigna, have been affected by this change.

For details about state-specific effective dates and claim filing limits, please refer to the Clinical, Reimbursement and Administrative Policy Update article on page 2. For more information about the change to claim filing limits, please see the full article in the July 2011 issue of Network News. n


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ClaimCheck 9.0 applied to GWH-Cigna claims

One secure website coming soonIn the coming months, we will transition to one secure website for both the Cigna and GWH-Cigna networks. Having one website can help you and your staff work more efficiently when verifying patient eligibility, submitting and checking claims, or accessing directories and reference guides. Over the next few months, we will communicate specific changes to you. Until that time, please continue to use Cigna’s separate websites for health care professionals.

For more information about changes we are making to improve your online experience, please refer to the article “Changes to improve your electronic experience” on page 6. n

As of November 7, 2011, ClaimCheck 9.0, the automated code auditing tool developed by McKesson, applies to claims for your patients with GWH-Cigna ID cards. With this change, ClaimCheck is now used for all Cigna medical claims to help expedite and improve the accuracy of claim processing.

ClaimCheck 9.0 aligns Cigna claims more closely with the Centers for Medicare and Medicaid Services (CMS), and improves processing and auditing capabilities, including modifier recognition, processing, and the application of CMS/National Correct Coding Initiative (NCCI) edits.

You may view both ClaimCheck and NCCI code edits by using the Clear Claim Connection™ code editing verification tool. This disclosure tool allows users to enter

Current Procedural Terminology (CPT) and Health Care Common Procedure Coding System (HCPCS) codes and immediately view the code audit results prior to submitting a claim. Clear Claim Connection shows NCCI edit definitions and the rationale behind a ClaimCheck edit. Clear Claim Connection is available on the secure Cigna websites, including the Secured Provider Portal (GWHCignaforHCP.com) and the Cigna for Health Care Professionals website (CignaforHCP.com).

For more information on ClaimCheck 9.0, refer to the Frequently Asked Questions available on the Secured Provider Portal (GWHCignaforHCP.com > Clinical Edit Verification). n


E L E C T r O n I C TOOLS

TestingCigna is testing electronic transaction enhancements in two phases:

Phase 1 | 3rd and 4th quarter – 2011 Phase 2 | 4th quarter – 2011

837I – Claim submission (institutional)837P – Claim submission (professional)837D – Claim submission (dental)835 – Payment and remittance advice277 – CA (claim acknowledgment)

270/271 Interactive276/277 Interactive278 Request/response interactive

Please work with your trading partners to identify their testing dates, and to confirm when they will be ready to accept 5010 transactions.

HIPAA 5010 updatesIn January 2009, the U.S. Department of Health and Human Services (HHS) published final rules adopting X12 Version 5010 for HIPAA electronic health care transactions. Use of version 5010 by HIPAA covered entities is required by January 1, 2012.

In addition to our efforts to comply with the HIPAA 5010 electronic transaction standards, Cigna has also made enhancements to these electronic transactions to help you complete administrative tasks more efficiently. These updates will be implemented in support of the migration from 4010 to 5010. Here are examples of the changes you will see:

• The“BillingProviderAddress”mustbeastreetaddress.APOorlockboxaddressshouldonlybe submitted in the “Pay to Provider” address field.

• SubscriberswillbeuniquelyidentifiedbytheirIDnumberacrossallHIPAAEDItransactions.

• The“ProviderAcceptsAssignment”indicatorwillberequiredonallclaims.

• Wewillprovideremittanceadviceremarkcodes(RARC)inadditiontotheclaimadjustmentreason codes (CARC) on the 835. This will give you a more detailed explanation of the difference between the billed amount and paid amount.

• Wewilladdhospitalandmentalhealthcoverageinformationtothe271eligibilityandbenefit response, as well as detailed urgent care benefits.

• A277claimacknowledgmentwillbesentforeveryclaimreceivedthroughthe Cigna gateway.

Please confirm that your system and vendor are set up to receive transactions from Cigna and that the appropriate format, usage, and code list updates have been made to avoid transaction rejections and claim processing delays.

When will I see these changes?You will experience these changes as your vendor begins to exchange 5010 transactions with Cigna. Some clearinghouses or vendors may begin automatically converting transactions between the current version (4010) and the new version (5010). As a result, you may notice these changes earlier or later than the date your system creates transactions in version 5010.

Check with your vendor or software supplier about their 5010 readiness and testing plan. Cigna will no longer accept 4010 transactions after a trading partner has migrated to 5010. n


E L E C T r O n I C TOOLS

Cost estimation capability now available for patients In 2009, we launched the Cigna Cost of Care Estimator® to help you accurately estimate what your patients with Cigna administered medical coverage may owe for your services, and what you can expect Cigna to pay you on their behalf.

The success of the tool and our continued efforts to help our customers make informed decisions about their health care have prompted us to extend this capability to our customers. This capability became available to your Cigna patients in November. Now they can access the quality and cost information necessary to make more informed health decisions for themselves and their families.

Using a secure website, your patients with Cigna administered medical coverage can:

• Locate doctors and services, and compare their quality and outcomes measures.

• Produce personalized cost estimates by health care professional or facility, which can help them make more informed decisions about their care.

• Research the costs of approximately 200 procedures.

The patient estimation capability is integrated into our health care professional search tool on the secure myCigna.com (myCigna.com > Find a Doctor), since it is often at this point when individuals decide which physician to choose to begin a treatment protocol.

The estimates produced are patient-specific and use real-time calculations of their liability including deductible, coinsurance and out-of-pocket maximums. The results are consistent with the estimates generated by you and other health care professionals using the Cigna Cost of Care Estimator tool available on the secure Cigna for Health Care Professionals website (CignaforHCP.com).

This new capability is an extension of our efforts to offer transparency to our customers, and help them better understand what they can expect to pay for services performed at a specific facility, or by a specific physician. n

Changes to improve your electronic experience We are working to improve your electronic experience with us by upgrading our suite of electronic data interchange (EDI) transactions and enhancing our website for health care professionals.

EDI transactions have become more useful. Changes to the eligibility and benefits transaction and the electronic remittance advice give you access to more complete benefits data, and allow you to save time by being able to automatically reconcile payments.

The secure Cigna for Health Care Professionals website (CignaforHCP.com) will be more patient-centric to help you and your staff locate the information you need quickly, and perform functions more efficiently. The improved website will also include new capabilities that you have requested, enhancements to the tools you use the most, and workspace utilities that should make the website easier to use. You will continue to have access to the resources, tools, and real-time transactions you and your staff use today to work more efficiently.

More information about our electronic upgrades and the improved Cigna for Health Care Professionals website will be communicated in future issues of this newsletter. n


Tools for improving claim processingCigna currently uses ClaimCheck® 8.5, a code auditing software, to expedite accurate claim processing. On October 17, 2011, we updated our ClaimCheck software to reflect KnowledgeBaseVersion47andNCCIVersion17.1 Column1/Column2 (Incidental) and Mutually Exclusive code edits.

You may view code edits by using Clear Claim Connection™. This disclosure tool allows health care professionals to enter CPT and Health Care Common Procedure Coding System (HCPCS) codes, and immediately view the code audit results prior to submitting a claim. Clear Claim Connection also shows NCCI edit definitions and the rationale behind a ClaimCheck edit.

YoucanviewtheCodeEditBulletin and Policy for information about recent updates to ClaimCheck and our modifier andreimbursementpolicies.Both documents are posted on the Cigna for Health Care Professionals website at CignaforHCP.com > eServices > View Claim Coding Edits.

Additional ClaimCheck and Clear Claim Connection information is available on the Cigna for Health Care Professionals website at CignaforHCP.com > eServices > View Claim

Coding Edits.* You can also access the Clear Claim Connection information on the Secured Provider Portal at GWHCignaforHCP.com.

To learn more about code edits on claims associated with claims for your patients with GWH-Cigna ID cards, please visit the Secured Provider Portal at GWHCignaforHCP.com > Tools & Resources > Clinical Edit Verification.

With this change, you will need to log in to the Cigna for Health Care Professionals website in order to submit claims online. If you are not registered for the website, please go to CignaforHCP.com and click “Register Now,” located in the left-side bar.

ClaimCheck coming to GWH-Cigna claimsAs of November 7, 2011, ClaimCheck 9.0 applies to claims for your patients with GWH-Cigna ID cards.

For more information about ClaimCheck for claims for your patients with a GWH-Cigna ID card, please refer to the article “ClaimCheck 9.0 applied to GWH-Cigna claims” on page 4. n

* Claim coding edit results are guidelines and not a guarantee of claim payment.

Cigna Voluntary Patients

Electronic eligibility and benefit information through Emdeon®Cigna received the CAQH® Committee on Operating Rules for Information Exchange® (CORE) Phase I health plan certification in April 2010. Since that time, we’ve been working to offer the same CORE Phase I compliant response across all Cigna products. We are pleased to announce that Cigna Voluntary now supports an electronic eligibility and benefit inquiry and CORE Phase I compliant response (ANSI 270/271) through Emdeon.

Emdeon is a leading provider of revenue and payment cycle management and clinical information exchange solutions, connecting payers, health care professionals, and patients in the U.S. health care system. Users of Emdeon Office, or vendors that connect to Cigna through Emdeon, can now verify the plan and certain benefit-specific coverage information for patients covered by Cigna Voluntary plans. Emdeon can:

• Determine if a benefit is covered

• Receive detailed copayment and coinsurance information for chiropractic, inpatient hospital, outpatient hospital, vision, pharmacy, and emergency services and professional office visits

These updates are available to vendors that support HIPAA ANSI 270/271 transactions through Emdeon connections or products. If you treat patients with Cigna Voluntary plans, please verify if your vendor contracts with Emdeon. n


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New hepatitis C therapyTwo new drugs, VictrelisTM (boceprevir) and IncivekTM (telaprevir) were recently introduced as new treatment therapies for hepatitis C. Bothdrugsoffernewhopetopatientswhoare infected with this virus. Studies submitted to the Food and Drug Administration (FDA) for approval of these drugs demonstrated that when taken correctly, Victrelis or Incivek results in an average cure rate of 78 percent.1 This is significant considering hepatitis C is the most common infection of the liver worldwide, and affects an estimated 130 to 210 million people.2

How Cigna is helpingAdherence is crucial in the success of these new complex hepatitis therapies. We are here to help your patients achieve optimal clinical outcomes by working with physicians and by offering the following pharmacy and clinical services that can help ensure patients are receiving and taking their medications appropriately:

Cigna Home Delivery Pharmacy Cigna Home Delivery Pharmacy is available to your patients for their prescription needs. Standard services include 24/7 availability of a licensed pharmacists, convenient home delivery or other preferred location at no additional cost, and automatic refill reminders.

Clinical program support Our clinical programs are available to support your patients with adherence and managing side effects, and to educate them about chronic conditions including hepatitis C:

• CoachRx – We can help patients become more compliant with taking their medication through condition education, text, telephone, and email reminders, and coaching, all based on the patient’s choice.

• Well Informed Gaps in Care program – This program analyzes an individual’s claim data and results against evidence-based medical standards to identify potential gaps in care. The program includes outreach to the individual and physician to inform of potential gaps in care.

• TheraCare® – We take a personalized integrated approach to care by focusing on your patient’s total health, not just their condition. A personalized team consisting of a therapy support coordinator and nurse can help to monitor side effects and medication adherence.

Prior authorization Victrelis and Incivek are covered under the Pharmacy benefit as non-preferred drugs and require prior authorization. These drugs can only be authorized when used in conjunction with Pegylated Interferon and Ribavirin to achieve the most favorable results. The revised prior authorization form is available on the Cigna for Health Care Professionals website (CignaforHCP.com > Pharmacy > Forms). n

1 FDA Advisory Committee Briefing Document. FDA Antiviral Drugs Advisory Committee Meeting: Boceprevir Capsules (NDA 202-258), March 29, 2011. FDA Advisory Committee Briefing Document. Vertex Pharmaceuticals Antiviral Drugs Advisory Committee Meeting: Telaprevir (NDA 201-917), April 28, 2011.

2 Craxi A, Pawlotsky J, Wedemyer H, et al. European Association for the Study of the Liver: EASL Clinical Practice Guidelines: Management of hepatitis C virus infection. Journal of Hepatology 2011 Vol. 55 p. 245-264.


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Market Medical Executives contact updateMedical director name Geographic area Telephone number

national responsibility Nicholas Gettas | Chief Medical Officer, Regional Accounts | 1.804.344.3038

Northeast region Dan Nicoll, MD, Regional Medical Director | NJ, NY | 1.201.533.4717

FrankBrown,MD DC, MD, VA 1.804.344.2384

Robert Hockmuth, MD CT, MA, ME, NH, RI, VT 1.603.268.7567

Peter W. McCauley, Sr., MD, CPE IL, IN, MN, WI 1.312.648.5131

Ronald Menzin, MD NJ , NY, Tri-state 1.631.247.4526

Christina Stasiuk, DO DE, MI, OH, PA, WV 1.215.761.7168

Southeast region Jordan Ginsburg | Regional Medical Director | KS, MO | 1.314.290.7308

Edward Hunsinger, MD NC, SC 1.336.945.6597

Ernest Cook, MD North FL 1.407.415.0874

Donald Grossman, MD South FL 1.954.514.6862

Robert McLaughlin, MD TN 1.423.763.6764

FrederickWatson,DO,MBA,CPE North TX 1.972.863.5119

MarkJ.Netoskie,MD,MBA,FAAP LA, South TX 1.713.576.4465

West Region Jennifer Gutzmore, MD | Regional Medical Director | CA | 1.818.500.6459

Jacob Asher, MD North CA 1.415.374.2520

Mark Laitos, MD CO, MT, NM, UT, WY 1.303.729.4705

MaryO’Neill,MD,MBA AK, HI, ID, OR, WA 1.206.625.8846

Jennifer Gutzmore, MD AZ 1.818.500.6459

We understand the importance of having Medical Directors who can work with you and recognize your needs on a local level. As part of our commitment to providing you with personalized service that can help answer your health care related questions, we list the most recent contact information for your regional and local Medical Directors, known as Market Medical Executives (MMEs).

Our medical executives cover specific geographic areas and understand the local community nuances in health care delivery. This allows our MMEs to provide you with a unique level of support and service.

We encourage you to call your local MME with general questions about Cigna’s clinical policies and clinical programs. Please review our updated list of MMEs. n

Cigna Centers of Excellence We evaluate hospital patient outcomes and cost-efficiency information through our Centers of Excellence program. We use this information to create hospital profiles, which contain information for up to 29 procedures and conditions. This information is available for most hospitals participating in our network.

The 2011 Centers of Excellence information is available in the online directory of health care professionals on Cigna.com, as well as our secure website for customers.

Please note that the existing 2011 profiles will remain in effect through 2012 and will not be updated.

Additional informationFor more information about our Centers of Excellence profiles, please refer to the Centers of Excellence/Hospital Value Tool 2011-2012 Methodology. which is available on the secure Cigna for Health Care Professionals website (CignaforHCP.com > Resources > Clinical Health and Wellness Programs > Centers of Excellence). Please call the Cigna Customer Service Center at 1.800.88Cigna (882.4462) if you do not have Internet access. n

Reasons to call your MME

• Ask questions and obtain general information surrounding Cigna’s clinical polices and clinical programs.

• Ask questions regarding your specific practice and utilization patterns.

• Report or request assistance around a quality concern involving your Cigna patient(s) and/or Cigna network health care professional(s).

• Request or discuss recommendations for improvements or development of Cigna’s 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.


Weight management support for your patientsStaying at a healthy weight is one of the best things people can do for their health. It can help prevent serious health problems, including heart disease, stroke, high blood pressure, type 2 diabetes, and sleep apnea.

We realize that our customers may need extra assistance to achieve their weight management goals and experience optimal health, so we offer supportive programs and services. As a health care professional, you have the opportunity to influence your patients’ health outcomes and encourage them to take advantage of the resources that are available to them through their Cigna plan.

Please consider suggesting these Cigna options to your patients who could benefit from additional support:

Cigna HealthCare 24-Hour Health Information LineSM – Your patients can reach a nurse to ask health care questions 24 hours a day, seven days a week, from anywhere in the United States. The service also offers a recorded audio tape library of more than 1,000 topics, including weight management and other wellness topics.

Cigna Well Aware for Better Health® – Our condition management programs help individuals with chronic conditions – many of which are linked to obesity – develop personalized action plans under the guidance of their physician. Your patient will have access to an experienced nurse to call for guidance and support, education materials, and self-care information.

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Healthy Rewards® – Our national amenities program provides your patients with access to complementary and alternative therapies at discounted prices, including discounts for fitness club memberships, pedometers, walking programs, health and wellness products, and the following programs and services:

• Weight management programs

– Healthyroads™ Weight Management Program

– Jenny Craig®

• Fitness

– Fitness club equipment discounts

– Just Walk 10,000 Steps-a-Day™

• Vitamins, health, and nutrition

– Registered dietician network

– ChooseHealthy™

– Drugstore.com™

Cigna plan participants can access information on Healthy Rewards at myCigna.com or by calling 1.800.870.3470.

In all areas of health, it’s important for individuals to have the information and services to make the right choices. We hope these Cigna tools and resources will complement your patients’ care and treatment plans.

For more information on weight management options available through Cigna’s health advocacy programs, please access the secure Cigna for Health Care Professionals website (CignaforHCP.com > Resources > Clinical Health and Wellness> Health Advocacy Fact Sheets). n

* Healthy Rewards is a discount program. Some Healthy Rewards programs are not available in all states. A discount program is not insurance, and the customer must pay the entire discounted charge.


Cultural competency training video now availableProviding quality health care requires effective communication between patients and their health care professionals. However, nearly half of all physicians in the United States report that their ability to provide quality care is affected by difficulty communicating with patients because of language or cultural barriers.1

A video on Cultural Competency is now available at no cost to registered users of the Cigna for Health Care Professionals website. The video is provided courtesy of the California Academy of Family Physicians (CAFP Foundation), the Medical Leadership Council on Cultural Proficiency (MLC), and The California Endowment. The focus of the video is on the role of medical assistants and

how they can improve cultural competency in a health care setting when communicating with your patients.

Cultural competency training can help practitioners build skills to better understand, and to communicate and effectively interact with, patients in cross-cultural encounters.2 Log in to CignaforHCP.com > Education and Help to view the video. n1 James D. Reschovsky, Ellyn R. Boukus. Modest and Uneven:

Physician Efforts to Reduce Racial and Ethnic Disparities. Issue Brief No. 130. February 2010. Center for Studying Health System Change.

2 Betancourt, Joseph R., et al., “Defining Cultural Competence: A Practical Framework for Addressing Racial/Ethnic Disparities in Health and Health Care,” Public Health Reports, Vol. 118 (July/August 2003).

Street address change for Cigna InternationalThe Cigna International office in Claymont, DE has moved to a new street address. As of August 15, 2011, all courier mail should be sent to:

Cigna International 300 Bellevue Parkway Wilmington, DE 19809 U.S.A.

Courier mail delivered to the old street address (590 Naamans Road) will be forwarded to the new address; however, the sender will be charged a $15.00 forwarding fee.

This address change applies to courier deliveries only; the P.O. Box address for regular postal deliveries and claim submission has not changed. That address remains:

Cigna International P.O.Box15050 Wilmington, DE 19850-5050 U.S.A.

Cigna International ID cards printed after September 1, 2011 will no longer include the street address on the card. n


Participate in the Leapfrog Hospital SurveyCigna endorses and encourages hospitals to participate in the Leapfrog Hospital Survey. We use hospital performance information collected from the survey in our Centers of Excellence Hospital Value Profile. This self-reported public data is one of the criteria used to assess participating hospitals for the Cigna Center of Excellence designation.

It’s not too late to participate in the 2011 survey Leapfrog continually updates and releases results on the fifth calendar day of each month through the end of the year. If you complete and submit a survey, or update a survey and re-submit it by month’s end, your hospital’s results will be reflected in the next monthly update. Hospitals that completed a survey before June 30, 2011 were included in Leapfrog’s first release of 2011 survey results in late July.

The Leapfrog Group, a non-profit organization, is committed to improving the quality of health care and patient safety while helping individuals make more informed health care choices. For more information, visit leapfroggroup.org. n

Cigna Care designation, and quality and cost-efficiency displaysCigna evaluates physician quality and cost-efficiency information. Participating physicians meeting specific criteria are assigned the Cigna Care designation.

The 2011 Cigna Care designation and quality information is available in the online directory of health care professionals on Cigna.com, as well as our secure website for customers. The cost-efficiency displays are available only on the secure website for individuals with Cigna coverage.

Please note that the existing 2011 profiles will remain in effect through 2012 and will not be updated.

For more information about Cigna Care designation, and quality and cost efficiency displays, please refer to the 2011 Cigna Care Designation and Physician Quality and Cost-Efficiency Displays Methodology, which is available on the secure Cigna for Health Care Professionals website (CignaforHCP.com > Resources > Clinical Health and Wellness Programs > Cigna Care Designation). Please call the Cigna Customer Service Center at 1.800.88Cigna (882.4462) if you do not have Internet access. n

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h E L P F U L rEmInDErS

Cigna Medicare Access® private fee-for-service call center closedIn January 2011, Cigna did not renew its contract with the Centers for Medicare and Medicaid Services (CMS) for Cigna Medicare Access private fee-for-service (PFFS) plans. However, Cigna continues to handle activities for these plans with dates of services prior to January 1, 2011.

The Cigna Medicare Access PFFS Customer Service Call Center no longer accepts telephone inquiries about Cigna Medicare Access PFFS plans, as of July 1, 2011. Only written inquiries are accepted.

Health care professionals with questions about Cigna Medicare Access PFFS plans can submit all customer service inquiries 24 hours a day, seven days a week by secure fax or email to:

Fax number: 1.866.257.4525

Email address: [email protected]

Continue to submit Cigna Medicare Access PFFS paper claims to: Cigna Medicare Access PFFS P.O.Box696018 San Antonio, TX 78269-6018

Electronic claims will be accepted through December 31, 2011, and should be sent to EDI Payer ID 86033.

Submit all other written correspondence to: Cigna Medicare Services PFFS P.O.Box696016 San Antonio, TX 78269-6016

Please ensure all requests include the following information so we may research your request as quickly as possible:

• NPI/tax ID

• Patient’s name

• Patient’s Cigna ID

• Patient’s date of birth

• Date(s) of service

• Besttelephonenumberandtime to reach you

• Secure email address and fax number

• Details related to your request n

Reference guides updated Cigna’s Reference Guides containing our administrative guidelines will be updated in the first quarter of 2012. The guides combine information for physicians, hospitals, ancillary facilities, and other health care professionals.

Access the new Cigna Reference Guide at either of the websites below. State-specific guides are also updated and posted, where applicable. You must be a registered user to access these sites.

•CignaforHCP.com > Resources > Reference Guides > Health Care Professional Reference Guides

•GWHCignaforHCP.com > Tools & Resources > Health Care Professional Reference Guide

Call 1.877.581.8912 to request a paper copy or a CD-ROM.

To promote administrative ease, the Cigna Reference Guide includes information pertaining to participants with GWH-Cigna ID cards. Please discontinue use of the separate Great-West Health Care Reference Guides and refer to the Cigna Reference Guide for all Cigna business. n

Urgent care for non-emergenciesTreatment of non-emergency or low-severity conditions in an emergency room can significantly increase your patients’ out-of-pocket costs compared to treatment at an urgent care center or a physician’s office. Please consider providing same-day appointment availability in your office. When your office is closed, consider whether it

would be appropriate to refer your patients to a participating urgent care clinic instead of the emergency room for non-life threatening conditions.

For a list of Cigna’s participating urgent care centers, view our Provider Directory at Cigna.benefitnation.net/Cigna/ docdir.aspx. n


Cigna debit card transactionsOur health care professional Reference Guides will be updated in January 2012 to provide information outlining how and when health care professionals should accept and use the Cigna debit card when presented by a Cigna plan participant.

The Cigna debit card should be used only for expenses referred to in the Internal Revenue Code section 213(d). Your patients may use their Cigna debit card to pay for accepted medical expenses through their Flexible Spending Account (FSA) and/or Health Reimbursement Account (HRA).

When a patient presents a Cigna debit card, please do not allow the card to be used

for non-eligible expenses, such as cosmetic procedures. When Cigna patients use their debit card for their in-network health care professional visits, substantiating these claims will help improve their experience and will also help improve how quickly we can issue payments to you.

Additional informationFor more information, including frequently asked questions, please visit the secure Cigna for Health Care Professionals website (CignaforHCP.com > News You Can Use).

We appreciate your cooperation with substantiating appropriate expenses. n

Use the network

h E L P F U L rEmInDErS

minimize their out-of-pocket expenses.

For a complete listing of:

• Cigna participating physicians and facilities, access the Cigna online provider directory at Cigna.com.

• Participating physicians and facilities that provide in-network services to individuals with GWH-Cigna ID cards, access the online provider directory at GWHCignaforHCP.com. n

Tell us what’s changed Have you recently changed addresses, specialty type, phone numbers, tax identification numbers, or have doctors left your group? It’s important to notify Cigna of these changes. Demographic information is used to process claims and to send you communications. It’s also published in the Cigna provider directories.

You may contact us as noted below or submit changes electronically using the online form available on the Cigna for Health Care Professionals website at CignaforHCP.com and on the Secured Provider Portal at GWHCignaforHCP.com. n

If you are located in:

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

CT, DE, IA, IL, IN, MA, ME, MI, NH, NJ, NY, OH, PA, RI, VT, WI, or WV


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


Fax: 1.860.687.7336

Mail:400NorthBrandBlvd.,Suite300,Glendale, CA 91203

Cigna contractually requires participating health care professionals to direct patient referrals to other participating, contracted physicians and facilities, except in the case of an emergency, as otherwise required by law, or unless approved by Cigna in advance of the service being provided.

Referring patients to other participating health care professionals helps preserve the intent of the patient to remain in-network for care. This maximizes the benefits available through their Cigna plans and helps them to


Change for the better Continued from page 1

• Explanation of Payment (EOP). Starting in October 2011, some of the EOP forms you receive from us have a new look. These updated EOPs include the new logo on the forms and attached checks.

• redesigned Cigna.com. In addition to displaying the new logo and the new way we write our name, our more user-friendly public website includes information about the benefi ts of Cigna and important information for you and your patients.

• Cigna for health Care Professionals website. Next year, we’ll unveil a newly designed secure website, one that can help you locate the information you need quickly, and perform functions more effi ciently. The new site for health care professionals will match the look and feel of the redesigned Cigna.com and include added capabilities, enhancements to the tools you use the most, and workspace utilities that can make the site easier to use.

We’re not changing the resources you use today and have come to rely on when you need to contact us:

– Electronic service and tools– Website addresses– Claim addresses– Claim submission processes– Customer service channelsAs you can see, these eff orts refl ect our commitment to providing better support for you and our customers. Look for more information in future editions of this newsletter. n

Shared benefi ts administrationTopic Contact

Reimbursement

Appeals

General questions

1.800.549.8908

Paper and electronic claim submission addresses

Precertifi cation

Telephone number or address on the patient’s ID card

Eligibility

Benefits

Claim status

Third-party administrator (TPA) telephone number or address on the patient’s ID card

We contract with Taft Hartley trusts and federal employee health benefi t plans to share the administration of their self-funded (ASO) plans. For these relationships, we may provide access to the Cigna network, perform medical management and utilization review, re-price claims according to our contracted rates and claims logic, provide clinical appeals management, or provide contract dispute resolution.

Information and help with certain matters related to ASO plans are available to you in the chart on the right. n

Cigna Attn: Health Care Professional Communications 900CottageGroveRoad,RoutingB7NC Hartford, CT 06152 1.800.88Cigna (882.4462)

Access the Archives Visit Cigna.com > Health Professionals > Newsletters to access articles from previous issues of Network News. Article topics are listed for each of the archived issues.

To access the current Network News on the Secured Provider Portal, visit GWHCignaforHCP.com > Health Care Professional Newsletter > Important Updates.

“Cigna” is a registered service mark and the “Tree of Life” logo is a service mark of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its operating subsidiaries. All products and services are provided by 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., 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.

848810 10/11 THN-2011-096 © 2011 Cigna. Some content provided under license.

Go green – go electronicWould 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

Byregistering,youwillreceivesomecorrespondenceelectronically, including Network News and other select communications. Certain correspondence will still be sent via 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 Cigna for Health Care Professionals website and receive electronic updates, go to CignaforHCP.com and click “Register Now.” n

We’ve improved Network News As you may have noticed, there are some changes in this month’s Network News. Here are some of the ways we’ve redesigned your newsletter to be more organized and reader-friendly and to reflect Cigna’s new brand (see “Cigna announces a change for the better” on page 1):

• Articlesaregroupedbytopicsofinteresttoyou.

• Wechangedthefontandincreasedthewhitespacearoundarticlesandparagraphsto make them easier for you to read.

• Weallowedenoughspacetothree-holepunchthenewsletterwithoutlosinganycontent because we realize many of you like to keep Network News in an archive.

We’re also making improvements to the look and navigation of the electronic version of Network News. You’ll see those changes in an upcoming issue. If you or anyone in your office would like to subscribe to the electronic version, find instructions in “Go green—go electronic” to the right.

In 2012, Network News will be issued four times per year instead of three times. We’re delivering the newsletter to you more often to ensure that you always have the most current information from Cigna. You’ll receive your next issue in January 2012.

Your comments or suggestions for the editor are always welcome. Please email [email protected] or write to:

CignaAttn: Health Care Professional Communications900CottageGroveRoad,RoutingB7NCHartford, CT 06152

848810 network news nov11 v13 - cigna · radiology benefit and network management services cigna...

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