The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. All pictures are used for illustrative purposes only. Cigna may not control the content or links of non-Cigna websites. Cigna insurance, now, offers both PPO and HMO plans. Individual and family medical and dental insurance plans are insured by Cigna Health and Life Insurance Company (CHLIC), Cigna HealthCare of Arizona, Inc., Cigna HealthCare of Illinois, Inc., Cigna HealthCare of Georgia, Inc., Cigna HealthCare of North Carolina, Inc., Cigna HealthCare of South Carolina, Inc., and Cigna HealthCare of Texas, Inc. Group health insurance and health benefit plans are insured or administered by CHLIC, Connecticut General Life Insurance Company (CGLIC), or their affiliates (see Selecting these links will take you away from Cigna Medicare Advantage and Medicare Part D Prescription Drug Plan information. Delivering medical providers with important news, including: Updates to Cigna's policies and procedures Announcements of new Cigna electronic tools and services Clinical, pharmacy, and Medicare Advantage updates Health-related news, trends, and more Read the current issue Behavioral Health: Transformations From professional newsletters to wellness programs to Cigna medical plans and more, this is the medical health care professional's source for information. 58 0 obj <> endobj Copyright and other intellectual property laws protect these materials. CocoDoc has made it easier for people to Modify their important documents by online browser. %PDF-1.5 % Visit the Provider Portal at HSConnectOnline.com. Cigna contracts with Medicare to offer Medicare Advantage HMO and PPO plans and Part D Prescription Drug Plans (PDP) in select states, and with select State Medicaid programs. Selecting these links will take you away from CignaforHCP.com. a listing of the legal entities Silver&Fit is a registered trademark of ASH and used with permission herein. If you're unable to file a claim right away, please make sure the claim is submitted accordingly. 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 eviCore supports the work of physicians and others who strive to reduce the overuse of diagnostic tests that are of low value, of no value, or where the risks of a given diagnostic test are greater than the benefits. eviCore has a national network of providers who offer these services. endobj As part of our continued effort to provide a high quality user experience while also ensuring the integrity of the information of those that we service is protected, Beginning Friday, December 18th at 5:00pm EST, you To order eviCore-provided services for your patients with Cigna-administered coverage, contact a participating provider. Details Apr 14, 2023 Feedback Will open a new window Find PA forms at MedicareProviders.Cigna.com > Forms and Practice Support > Prior Authorization Requirements. For availability, costs and complete details of coverage, contact a licensed agent or Cigna sales representative. 3269 0 obj <>/Filter/FlateDecode/ID[<2E60FC638041A04290D8E725F3905F1C>]/Index[3250 28]/Info 3249 0 R/Length 99/Prev 521572/Root 3251 0 R/Size 3278/Type/XRef/W[1 3 1]>>stream All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation. We're here to help. Privacy Policy | To find a participating provider, call eviCore at 800.298.4806 or go to Cigna.com > Find a Doctor. Details. Provider Customer Service: 1 (800) 230-6138, Provider Website: MedicareProviders.Cigna.com, Provider Manual: 2022 Provider Manual [PDF], ID Card Examples: 2022 Provider Manual [PDF] > Customer Identification Cards, Provider Portal: HSConnectOnline.comHelp Desk: 1 (866) 952-7596Email: HSConnectHelp@HSConnectOnline.com, ICD-10 Coding & Documentation/360 Comprehensive Assessment:Provider Education and Assessment Tools, Quest Diagnostic LaboratoriesCall: 1 (866) 697-8378. vaccine, please review our . If Medicare is the Secondary Payer (MSP), the initial claim must be submitted to the primary payer within Cigna's timely filing period. An initial determination on a previously adjudicated claim may be reopened for any reason for one year from the date of that determination. Get Adobe Reader. eviCore made it easy to complete my primary task online. %PDF-1.4 This web site uses files in Adobe Acrobat Portable Document Format (PDF). 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. In order to have the best experience on Cigna.com, Javascript needs to be enabled. hbbd```b``kd d im "YC'`S`q{4.F wHeg`bdq m#@g l< Cigna Coronavirus (COVID-19) Interim Billing Guidance for Providers for Commercial Customers Last updated February 15, 2023 - Highlighted text indicates updates The White House announced the intent to end both the COVID-19 national emergency and public health emergency (PHE) on May 11, 2023. endstream endobj 59 0 obj <>>> endobj 60 0 obj <. that insure or administer group HMO, dental HMO, and other products or services in your state). ALL RIGHTS RESERVED. wont be able to apply to eviCore openings. Your secure provider portal for working with Cigna The information, tools, and resources you need to support the day-to-day needs of your office are all on the Cigna for Health Care Providers' website, CignaforHCP.com : Check patient eligibility and benefits Check claims, payments, and fee schedules Update your Cigna provider directory information E-Verify and IER Right to Work. These guidelines apply to Cigna Medicare Advantage customers. endobj Medical technology is continuously evolving; the guidelines undergo a formal review annually, however eviCore reserves the right to change and update the guidelines without prior notice. CHCP - Resources - Medical Reference Guides Commercial Medical Reference Guides Medical Reference Guides Here you'll find reference guides to help make it easier for health care professionals to do business with Cigna. &+3gdn WZ!'H7}k+Vai|F_*H|NW _[GJ[okazk4Rw3iR\_[Jn2Y{beL_ek^ax66Pwwz^Hm/(1WLdrJ|zGLDDh @`l"L@SbOD4 E V&74Z}? hbbd```b`:" l,3!V "@|j0$> 0L[+&00Fr G(9J'(9Ft5JJgx s Medicare patients' claims must be filed no later than the end of the calendar year following the year in which the services were provided. Oscar is an HMO with a Medicare contract. that insure or administer group HMO, dental HMO, and other products or services in your state). CoverMyMeds: Website: CoverMyMeds.com (Preferred)Call: 1 (877) 813-5595Fax: 1 (866) 845-7267, 2022 Medicare Advantage Drug Formulary: MedicareProviders.Cigna.com > Pharmacy Resources, To evaluate patient eligibility for a patient support program, access our Patient Support Programs: MedicareProviders.Cigna.com > Patient Support Programs. For availability, costs and complete details of coverage, contact a licensed agent or Cigna sales representative. For provider resources or customer service: Provider Resources www.eviCore.com/Resources/Healthplan/Cigna-Medicare, Clinical Guidelines: www.eviCore/com/Provider/Clinical-Guidelines, Web Portal Support:Email: PortalSupport@eviCore.comCall: 1 (800) 646-0418 (option 2), Non-Precertification Inquiries:ClientServices@eviCore.comCall: 1 (800) 575-4517 (option 3), Clinical Support/Program Inquiries:Email: ClientServices@eviCore.comCall: 1 (888) 693-3211Fax: 1 (888) 693-3210, Medical Oncology:Call: 1 (866) 668-9250Fax: 1 (800) 540-2406, Radiation Therapy:Call: 1 (866) 686-4452Fax: 1 (866) 699-8128, Provider Resources:Call: 1 (888) 693-3297Fax: 1 (888) 693-3210Send clinical questions/case examples to eviCores client and provider service team, Clinical Support/Program Inquiries:Email: ClientServices@eviCore.comCall: 1 (800) 298-4806PAC Fax: 1 (800) 575-4429HHC Fax: 1 (855) 826-3724, Call: 1 (866) 686-4452Fax: 1 (866) 663-7740. These guidelines are not intended to supersede or replace sound medical judgment, but instead should facilitate the identification of the most appropriate imaging procedure given the individual's clinical condition. Details. %%EOF Selecting these links will take you away from Cigna.com to another website, which may be a non-Cigna website. In addition to the RFI content , Cigna LifeSOURCE annually evaluates each transplant program to determine continued compliance with established guidelines . These guidelines are written to cover medical conditions as experienced by the majority of individuals. To view or print these files, you must download and install the free Adobe Acrobat Reader. <> stream 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 Were still hiring for other Optum Womens and Childrens Health, LLC: Healthy Connections Home Care Services, Inc.: Compression therapy products for lymphatic and venous disorders, DME, including off the shelf and drop ship to home (i.e., braces, splints, slings, canes, walkers, prefabricated O&P, and knee supports). All insurance policies and group benefit plans contain exclusions and limitations. 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. 3 0 obj Copyright 2022 eviCore healthcare. Annual Utilization Statistics | General Information: Provider Customer Service: 1 (800) 230-6138 Provider Website: MedicareProviders.Cigna.com Provider Manual: 2022 Provider Manual [PDF] ID Card Examples: 2022 Provider Manual [PDF] > Customer Identification Cards Provider Portal: HSConnectOnline.com Help Desk: 1 (866) 952-7596 Email: HSConnectHelp@HSConnectOnline.com ICD-10 Coding & Documentation/ Please click here to register for an account. Provider Reference Guide - Baylor Scott & White Health Plan They can easily Tailorize through their choices. 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). ?siuC~62Ovxy:5igu+aF7c 3277 0 obj <>stream By using this site, you acknowledge that this material is copyrighted and agree to the terms and conditions noted above. 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. To learn more about a program, or request a patient eligibility evaluation, email CignaRefer_Help@Cigna.com. If you have any questions or would like more information about participating in a Cigna health care network, please contact us. Cigna may not control the content or links of non-Cigna websites. As always, you can appeal denied claims if you feel an appeal is warranted. HEALTH CARE PROFESSIONALS PROVIDER MANAUL MEDICARE ADVANTAGE PCOMM -2021-1083 8/21 HEALTH CARE PROFESSIONALS PROVIDER MANAUL MEDICARE ADVANTAGE 2021 Return to Table of Contents Page 2of 113 All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation. Use our self-service guidance and support form to easily find answers and resources for the most common inquiries. Committed to cultural competency. open positions so continue your job search at Cigna.com/careers, Clinical Information to Establish Medical Necessity, Peripheral Nerve Disorders Imaging Guidelines, Peripheral Vascular Disease Imaging Guidelines, Pediatric Musculoskeletal Imaging Guidelines, Pediatric Peripheral Nerve Disorders Imaging Guidelines, Pediatric Peripheral Vascular Disease Imaging Guidelines, Radiation Oncology Clinical Appeal Documentation Requirements, Bone Metastases - Xofigo Physician Worksheet, Central Nervous System Lymphoma Physician Worksheet, Central Nervous System Neoplasm Physician Worksheet, Extracranial Oligometastases Physician Worksheet, Gastric Stomach Cancer Physician Worksheet, Liver Cancer, Selective Internal Radiation Therapy Physician Worksheet, Non Cancerous Radiation Therapy Physician Worksheet, Non-Hodgkins Lymphoma Physician Worksheet, Non-Small Cell Lung Cancer CDS Online Document, Other Metastases (Non-Bone/Brain) Physician Worksheet, Lung Cancer, Small Cell Physician Worksheet, Prophylactic Cranial Irradiation (PCI) Radiation Therapy Physician Worksheet, Ureter/Urethral Cancer Physician Worksheet, Site of Care: Outpatient Hospital for Select Musculoskeletal Procedures, Interventional Pain Management Quick Reference Guide Guideline, Joint Surgery Quick Reference Guide Guideline, Preface to Comprehensive Musculoskeletal Management Guidelines, Epidural Adhesiolysis (CMM-207) Guideline, Epidural Adhesiolysis (CMM-207) Guideline - Effective 05/31/2023, Epidural Steroid Injections (CMM-200) Guideline, Epidural Steroid Injections (CMM-200) Guideline - Effective 05/31/2023, Facet Joint Injections / Medial Branch Blocks (CMM-201) Guideline, Facet Joint Injections / Medial Branch Blocks (CMM-201) Guideline - Effective 05/31/2023, Hip Replacement/Arthroplasty (CMM-313) Guideline - Effective 05/31/2023, Hip Replacement/Arthroplasty (CMM-313) Guideline, Hip Surgery Arthroscopic and Open Procedures (CMM-314) Guideline, Hip Surgery Arthroscopic and Open Procedures (CMM-314) Guideline - Effective 05/31/2023, Implantable Intrathecal Drug Delivery System (CMM-210) Guideline, Implantable Intrathecal Drug Delivery System (CMM-210) Guideline - Effective 05/31/2023, Knee Replacement Arthroplasty (CMM-311) Guideline - Effective 05/31/2023, Knee Replacement Arthroplasty (CMM-311) Guideline, Knee Surgery: Arthroscopic and Open Procedures (CMM-312) Guideline - Effective 05/31/2023, Knee Surgery: Arthroscopic and Open Procedures (CMM-312) Guideline, Prolotherapy (CMM-204) Guideline - Effective 05/31/2023, Radiofrequency Joint Ablations/Denervations (CMM-208) Guideline - Effective 05/31/2023, Radiofrequency Joint Ablations/Denervations (CMM-208) Guideline, Regional Sympathetic Blocks (CMM-209) Guideline, Regional Sympathetic Blocks (CMM-209) Guideline - Effective 05/31/2023, Sacroiliac Joint Procedures (CMM-203) Guideline, Sacroiliac Joint Procedures (CMM-203) Guideline - Effective 05/31/2023, Shoulder Surgery (CMM 315) Arthroscopic and Open Procedures Guideline - Effective 05/31/2023, Shoulder Surgery (CMM 315) Arthroscopic and Open Procedures Guideline, Shoulder Arthroplasty/ Arthrodesis (CMM-318) Guideline - Effective 05/31/2023, Shoulder Arthroplasty/ Arthrodesis (CMM-318) Guideline, Spinal Cord and Dorsal Root Ganglion Stimulation (CMM-211) Guideline - Effective 05/31/2023, Spinal Cord and Dorsal Root Ganglion Stimulation (CMM-211) Guideline, Gastrointestinal Endoscopic Procedure Esophagogastroduodenoscopy (EGD), Gastrointestinal Endoscopic Procedure Esophagogastroduodenoscopy (EGD) - Effective 06/15/2023, Gastrointestinal Endoscopic Procedure Capsule Endoscopy, Gastrointestinal Endoscopic Procedure Capsule Endoscopy - Effective 06/15/2023, Error All insurance policies and group benefit plans contain exclusions and limitations. % hb``b``Ab,nF )H\g```h i~ a,g}]Ig]7 1fq61` v T ob!!|Fy JC Request a Consultation with a Clinical Peer Reviewer, Check Status Of Existing Prior Authorization, Check Status of Existing Prior Authorization, Computed Tomography (CT) and Computed Tomography Angiography (CTA), Magnetic Resonance Imaging (MRI) and Magnetic Resonance Angiography (MRA), The terms of the applicable coverage plan document in effect on the date of service, Any relevant collateral source materials including clinical guidelines, The specific facts of the particular situation. Health care providers remain the %%EOF You may request precertification through eviCore in the following ways: For additional information, refer to eviCores provider resources website (www.eviCore.com/resources/healthplan/Cigna). You may save, download and print these guides for use in your office. we will be implementing changes to evicore.com in the near future. Using these recommended billing guidelines and codes will help facilitate proper reimbursement and help to avoid errors and potential reimbursement delays. x}s[}5@IN[I;eo2'u:MOmD$EYjmv:lGRh8Y*Ix\2;v#uc7M:t?ps. Facilities considered for the Cigna LifeSOURCE Transplant N etwork must be a Cigna-participating provider and maintain hospital accreditation (e.g., Joint Commission of Hospital a listing of the legal entities Please call QualCare Provider Relations at 800.992.6613 if you have any questions or concerns. Member Rights Policy | If a claim was timely filed originally, but Cigna requested additional information. Remember: Your contract with Cigna prohibits balance billing your patient if claims are denied because they were not submitted within the time frame outlined above. Bardy Diagnostics, Inc. dba BDx Solutions, Inc.: Boston Scientific (Preventice Services, LLC): Pacemaker Monitoring Center, Inc. dba Cardiac Monitoring Center: International normalized ratio services and rapid diagnostic test to measure clotting time for patients using blood thinners. endstream endobj startxref hbbd``b` SK(La "$[" rD @Ua$"C 6#I#s Z Ethics & Compliance | *The Silver&Fit program is provided by American Specialty Health Fitness, Inc., a subsidiary of American Specialty Health Incorporated (ASH). April 1 - September 30) Cigna Medicare Advantage Plans (Arizona Only) 1 (800) 627-7534 (TTY 711) 8:00 am 8:00 pm Mountain time, 7 days a week For prior authorizations, access our interactive Prior Authorization Requirements (a searchable reference guide updated quarterly) at MedicareProviders.Cigna.com > Forms and Practice Support > Prior Authorization Requirements. Updates to Cigna's policies and procedures, Announcements of new Cigna electronic tools and services, Clinical, pharmacy, and Medicare Advantage updates. providers according to plan rules as listed in the online provider manual. reCAPTCHA is not valid; Please try again! that insure or administer group HMO, dental HMO, and other products or services in your state). However, these guidelines may not be applicable in certain clinical circumstances. Browse Medical Resources Medical Reference Guides Here you'll find reference guides to help make it easier for health care professionals to do business with Cigna. Medicare and commercial manuals 2022 Provider manual for physicians, hospitals and healthcare providers - effective March 15, 2022 2022 Provider manual for physicians, hospitals and healthcare providers - delegation - effective March 15, 2022 2023 Provider manual for physicians, hospitals and healthcare providers - effective March, 1 2023 Need help? If Medicare is the primary payer, timely filing is determined from the processing date indicated on the primary carrier's explanation of benefit (EOB). Q4: How can eviCore make it easier for you to use this website? Whether you need to stay informed on Cigna policies, want to check out an informative webinar, or are looking for the latest news on Medicare, youll find it here with our newsletters, dedicated to keeping health care providers at the top of their game. To make updates , please notify QualCare Provider Relations. hTkSW?%yy$^5%VS&`Zc/JPZi(t45?lM.X Vb!1ZP&V8f[_2r}Iss/ 0S3UU%j9(UTT ( *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * Coverage determinations in each specific instance require consideration of: eviCore's guidelines are based upon major national and international association and society guidelines and criteria, peer-reviewed literature, major treatises, and input from health plans, practicing academic and community-based physicians. <> In Network Providers - Set up ACH/EFT Payments, Out of Network Providers - ACH/ERA Enrollment, Out of Network Providers - Claims Disputes, Optum Behavioral Health Toolkit for Providers, Behavioral Health HEDIS Measures Summary for Primary Care, Important information about Coordinating Care, Care for Individuals Diagnosed with Schizophrenia, Metabolic Screening for Children and Adolescents on Antipsychotics, Opioid Use Disorder Quick Reference Guide. Q1: Overall, how satisfied are you with eviCores website? 1 (800) 668-3813 (TTY 711) 8:00 am 8:00 pm your local time, 7 days a week (Messaging service used weekends, after hours, and Federal holidays from . Cigna.com no longer supports the browser you are using. This is useful for forms that you want to view and/or print. Cigna does not control the linked sites' content or links. Selecting these links will take you away from Cigna.com to another website, which may be a non-Cigna website. Watch this presentation to learn more about cultural competence and the important role you play as a provider. However, the filing limit is extended another full year if the service was provided during the last three months of the calendar year. 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. Cookies are not enabled, for best results please enable cookies. Individual and family medical and dental insurance plans are insured by Cigna Health and Life Insurance Company (CHLIC), Cigna HealthCare of Arizona, Inc., Cigna HealthCare of Illinois, Inc., Cigna HealthCare of Georgia, Inc., Cigna HealthCare of North Carolina, Inc., Cigna HealthCare of South Carolina, Inc., and Cigna HealthCare of Texas, Inc. Group health insurance and health benefit plans are insured or administered by CHLIC, Connecticut General Life Insurance Company (CGLIC), or their affiliates (see For information on Oscars policies and procedures, For the A to Z on Oscar's clinical criteria, For current state-specific reimbursement policies, For general Quality information and improvement guides. This website is not intended for residents of New Mexico. %PDF-1.7 % eviCore has a national network of providers who offer these services. On January 1, 2023, eviCore began managing the provider network for orthotics and prosthetics (O&P) services for Cigna commercial customers. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna. endstream endobj 4811 0 obj <. %PDF-1.6 % For availability, costs and complete details of coverage, contact a licensed agent or Cigna sales representative. Reproduction or retransmission of the materials, in whole or in part, in any manner, without the prior written consent of the copyright holder, is a violation of copyright law. Cigna may not control the content or links of non-Cigna websites. We'll discuss the salient differences between them to make selection easier - and more accurate - for you: Provider networks Unlike in an HMO plan where you must visit your PCP and maintain one all year-long, you don't have to do that. Terms of Use | We take on the administrative burden so you can focus on getting patients the care they need, and get paid in a timely manner. Read our quick-reference guide (PDF) Network participation criteria We have a set of criteria for participation in our provider network.
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