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. endobj providers according to plan rules as listed in the online provider manual. 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. ALL RIGHTS RESERVED. IMPORTANT: In the coming days, we will be migrating systems for our a listing of the legal entities 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, Cigna Medicare Advantage Plans . 3 0 obj Enrollment in Oscar depends on contract renewal. This website is not intended for residents of New Mexico. hbbd```b``kd d im "YC'`S`q{4.F wHeg`bdq m#@g l< These include: If you are not currently registered for the Cigna for Health Care Providers website, go to CignaforHCP.com and click on the Login/Register link. This website is not intended for residents of New Mexico. All insurance policies and group benefit plans contain exclusions and limitations. %PDF-1.6 % If services are rendered on consecutive days, such as for a hospital confinement, the limit will be counted from the last date of service. CHCP - Resources - Durable medical equipment (including - Cigna x}s[}5@IN[I;eo2'u:MOmD$EYjmv:lGRh8Y*Ix\2;v#uc7M:t?ps. hTkSW?%yy$^5%VS&`Zc/JPZi(t45?lM.X Vb!1ZP&V8f[_2r}Iss/ 0S3UU%j9(UTT ( endstream endobj 59 0 obj <>>> endobj 60 0 obj <. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna. Visit the Provider Portal at HSConnectOnline.com. All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation. 75 0 obj <>/Filter/FlateDecode/ID[<6199C9EC628D61409439B9F09F0CF70A>]/Index[58 71]/Info 57 0 R/Length 86/Prev 105393/Root 59 0 R/Size 129/Type/XRef/W[1 2 1]>>stream Thank you for the quality care you provide to our members. Provider customer service 1.800.230.6138 Provider website MedicareProviders.Cigna.com Provider manual MedicareProviders.Cigna.com > 2023 Provider Manual ID card examples MedicareProviders.Cigna.com > 2023 Provider Manual > 2023 Customer Identification Cards Provider portal HSConnectOnline.com Help Desk: 1.866.952.7596 Email: HSConnectHelp@ This web site uses files in Adobe Acrobat Portable Document Format (PDF). 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. When to File Claims | Cigna 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 Selecting these links will take you away from CignaforHCP.com. 4828 0 obj <>/Filter/FlateDecode/ID[<6BC9DFFB7467AF4AB407F2A14C4E167D><84593DD970E2D74EA4BE0EDE70F6ABF6>]/Index[4810 472]/Info 4809 0 R/Length 127/Prev 809539/Root 4811 0 R/Size 5282/Type/XRef/W[1 3 1]>>stream If Medicare is the primary payer, timely filing is determined from the processing date indicated on the primary carrier's explanation of benefit (EOB). Selecting these links will take you away from Cigna Medicare Advantage and Medicare Part D Prescription Drug Plan information. 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). Message Here. CHCP - Resources - Clinical Reimbursement Policies and Payment - Cigna Other names or logos may be trademarks of their respective owners. Need help? In addition to the RFI content , Cigna LifeSOURCE annually evaluates each transplant program to determine continued compliance with established guidelines . You may save, download and print these guides for use in your office. endobj 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. Committed to cultural competency. These guidelines apply to Cigna Medicare Advantage customers. After one year and prior to four years from the date of determination, "good cause" is required for Medicare to reopen the claim. Q1: Overall, how satisfied are you with eviCores website? &+3gdn WZ!'H7}k+Vai|F_*H|NW _[GJ[okazk4Rw3iR\_[Jn2Y{beL_ek^ax66Pwwz^Hm/(1WLdrJ|zGLDDh @`l"L@SbOD4 E V&74Z}? Medical and Dental 1 (800) 88CIGNA (882-4462) Behavioral 1 (800) 926-2273 Pharmacy Email us The Cigna Group Information Disclaimer 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. 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. Thank you for using eviCores website today! reCAPTCHA is not valid; Please try again! that insure or administer group HMO, dental HMO, and other products or services in your state). Ethics & Compliance | Cultural competency training video. Details Apr 14, 2023 Feedback Will open a new window <> that insure or administer group HMO, dental HMO, and other products or services in your state). Health Care Providers | Cigna Annual Utilization Statistics | This is useful for forms that you want to view and/or print. For additional information on our coverage and reimbursement of the COVID-19. Use our self-service guidance and support form to easily find answers and resources for the most common inquiries. It's best to submit claims as soon as possible. Get Adobe Reader. ?siuC~62Ovxy:5igu+aF7c Selecting these links will take you away from Cigna.com to another website, which may be a non-Cigna website. 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. Provider manuals - Aetna By using this site, you acknowledge that this material is copyrighted and agree to the terms and conditions noted above. To learn more about a program, or request a patient eligibility evaluation, email CignaRefer_Help@Cigna.com. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. All pictures are used for illustrative purposes only. To order eviCore-provided services for your patients with Cigna-administered coverage, contact a participating provider. 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. Medicare patients' claims must be filed no later than the end of the calendar year following the year in which the services were provided. @ >9{$I@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@`t3186?;>YY_H@kukU%dL@3!7aPf47J@&2@#j8H8N YBiYB`h2052b4e"F GfCIUKF3L[e%,d Y gY")% y\ UP2 M|1B~ eviCore is responsible for the following: The following table provides examples of eviCore-provided services. endstream endobj startxref Beginning Friday, December 18th at 5:00pm EST, you PDF Provider Reference Guide - Baylor Scott & White Health Plan Using these recommended billing guidelines and codes will help facilitate proper reimbursement and help to avoid errors and potential reimbursement delays. a listing of the legal entities These guidelines are written to cover medical conditions as experienced by the majority of individuals. %PDF-1.7 % eviCore positions. An initial determination on a previously adjudicated claim may be reopened for any reason for one year from the date of that determination. However, the filing limit is extended another full year if the service was provided during the last three months of the calendar year. 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. 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 | Privacy Policy | of authorization request(s). As of February 1, 2021, eviCore healthcare (eviCore) manages home health care, durable medical equipment (DME), and home infusion therapy for Cigna commercial customers. Were still hiring for other Provider Reference Guide - Baylor Scott & White Health Plan Cookies are not enabled, for best results please enable cookies. Health care providers remain the Please call QualCare Provider Relations at 800.992.6613 if you have any questions or concerns. PDF QANI Reference Guide for physicians, hospitals, ancillaries, and other 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. 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. However, these guidelines may not be applicable in certain clinical circumstances. 3250 0 obj <> endobj PDF PROVIDER REFERENCE GUIDE - Cigna, a Global Health Insurance and Health Keeping Dental Health providers up to date. %%EOF The website includes several educational materials: frequently asked questions documents, quick reference guides, provider training presentations, DME and O&P precertification form, and lists of Healthcare Common Procedure Coding System codes that require precertification through Cigna. <> *The Silver&Fit program is provided by American Specialty Health Fitness, Inc., a subsidiary of American Specialty Health Incorporated (ASH). vaccine, please review our . Cigna insurance, now, offers both PPO and HMO plans. Appeals and Disputes HIPAA Transaction Standards Questions? As a valued user of our website, wed appreciate your feedback to help us improve your website experience. We are committed to ensuring that your participation in the QualCare network is a positive and beneficial experience. PDF 2021 Medicare Provider Manual Cigna Medicare Advantage Providers in Arizona Find PA forms at MedicareProviders.Cigna.com > Forms and Practice Support > Prior Authorization Requirements. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna. Cigna Billing Manual Form: Fillable, Printable & Blank PDF Form for 5281 0 obj <>stream CHCP - Resources - Reference Guides - Cigna Claims questions: 1 (800) 230-6138 | Appeals questions: 1 (800) 511-6943 | Fax: 1 (800) 931-0149Electronic claims may be submitted through: Paper Claims: Cigna Medicare Advantage, PO Box 981706, El Paso, TX 79998Appeals: Cigna Medicare Advantage Appeals, PO Box 188081, Chattanooga, TN 37422Reconsideration Requests: Cigna Medicare Advantage Reconsiderations, PO Box 20002 Nashville, TN 37202, Mail: Cigna Medicare AdvantageAttn: Special Investigations UnitPO Box 20002, Nashville, TN 37202, Email: SpecialInvestigations@Cigna.comAttn: Cigna Medicare Operations. Read our quick-reference guide (PDF) Network participation criteria We have a set of criteria for participation in our provider network. Good health and a good doctor/patient relationship begins with understanding your patients' cultural, ethnic, racial and linguistic needs. PDF Health Care Professionals Provider Manaul Medicare Advantage %%EOF hb```, cb@1FFAA/j8Dcj29vPh Health Care Provider Newsletters | Cigna Cigna does not control the linked sites' content or links. They can easily Tailorize through their choices. hb``b``Ab,nF )H\g```h i~ a,g}]Ig]7 1fq61` v T ob!!|Fy JC Watch this presentation to learn more about cultural competence and the important role you play as a provider. Beginning on 3/15/21, web users will be required to log in to evicore.com in order to check the status hbbd``b` SK(La "$[" rD @Ua$"C 6#I#s Z For Cigna Medicare membership guidelines click here. Cigna may not control the content or links of non-Cigna websites. 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. 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. Provider Manual For information on Oscar's policies and procedures Clinical Guidelines For the A to Z on Oscar's clinical criteria Reimbursement Policies For current state-specific reimbursement policies STAR Resources For general Quality information and improvement guides Contact Us Need help? % 128 0 obj <>stream 0 All insurance policies and group benefit plans contain exclusions and limitations. Provider manuals You will find guides to support you in providing care, managing your practice and working with us. CHCP - Resources - Cigna's response to COVID-19 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. Provider Resources - hioscar.com guidelines at-a-glance flyer or visit our updated provider COVID-19 web page at CignaforHCP.com. To submit a Prior Authorization request:Visit the Provider Portal at HSConnectOnline.com. 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. Encouraging patients to get vaccinated. CHCP - Resources - Medical Reference Guides - Cigna we will be implementing changes to evicore.com in the near future. For availability, costs and complete details of coverage, contact a licensed agent or Cigna sales representative. 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 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 availability, costs and complete details of coverage, contact a licensed agent or Cigna sales representative. 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. Clinicians are expected to use independent medical judgment which takes into account the clinical circumstances to make individual management decisions. Member Rights Policy | eviCore has a national network of providers who offer these services. %PDF-1.4 Quick Reference Guide | Cigna Medicare Providers See the criteria (PDF) Office manual for health care professionals 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 <> stream Delivering medical providers with important news, including: Connecting Behavioral Health Care Providers with recent news. Updates to Cigna's policies and procedures, Announcements of new Cigna electronic tools and services, Clinical, pharmacy, and Medicare Advantage updates. 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.