endstream endobj startxref Please click here to register for an account. These guidelines apply to Cigna Medicare Advantage customers. 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 1 0 obj Ethics & Compliance | See the criteria (PDF) Office manual for health care professionals 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 eviCore has a national network of providers who offer these services. You may save, download and print these guides for use in your office. 1 Cigna may request appropriate evidence of extraordinary circumstances that prevented timely submission (e.g., natural disaster). This website is not intended for residents of New Mexico. 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. endstream endobj startxref %PDF-1.4 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. 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. vaccine, please review our . 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). Use our self-service guidance and support form to easily find answers and resources for the most common inquiries. 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. If you're unable to file a claim right away, please make sure the claim is submitted accordingly. hbbd```b`:" l,3!V "@|j0$> 0L[+&00Fr G(9J'(9Ft5JJgx s All insurance policies and group benefit plans contain exclusions and limitations. x}s[}5@IN[I;eo2'u:MOmD$EYjmv:lGRh8Y*Ix\2;v#uc7M:t?ps. Updates to Cigna's policies and procedures, Announcements of new Cigna electronic tools and services, Clinical, pharmacy, and Medicare Advantage updates. eviCore made it easy to complete my primary task online. %%EOF For additional information on our coverage and reimbursement of the COVID-19. If a claim was timely filed originally, but Cigna requested additional information. cigna commercial provider manual 2021; How to Easily Edit Cigna Billing Manual Form Online. These guidelines are written to cover medical conditions as experienced by the majority of individuals. If these clinical guidelines are inconsistent with the terms of the individual's specific coverage plan, then the terms of the individual's coverage plan always takes precedence. Additional clinical guidelines may be developed as needed or may be withdrawn from use. 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. To search the Prior Authorization guide for a code, enter Ctrl+F > the 5-digit code. wont be able to apply to eviCore openings. Need help? Details. 3250 0 obj <> endobj Cultural competency training video. that insure or administer group HMO, dental HMO, and other products or services in your state). Committed to cultural competency. However, the filing limit is extended another full year if the service was provided during the last three months of the calendar year. Using these recommended billing guidelines and codes will help facilitate proper reimbursement and help to avoid errors and potential reimbursement delays. Member Rights Policy | 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. Durable medical equipment (including orthotics and prosthetics), home health, and home infusion As of February 1, 2021, eviCore healthcare (eviCore) manages home health care, durable medical equipment (DME), and home infusion therapy for Cigna commercial customers. 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. This web site uses files in Adobe Acrobat Portable Document Format (PDF). If you have any questions or would like more information about participating in a Cigna health care network, please contact us. For availability, costs and complete details of coverage, contact a licensed agent or Cigna sales representative. @ >9{$I@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@`t3186?;>YY_H@kukU%dL@3!7aPf47J@&2@#j8H8N YBiYB`h2052b4e"F GfCIUKF3L[e%,d Y gY")% y\ UP2 M|1B~ Cigna insurance, now, offers both PPO and HMO plans. Please call QualCare Provider Relations at 800.992.6613 if you have any questions or concerns. 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. For Cigna Medicare membership guidelines click here. Details. To submit a Prior Authorization request:Visit the Provider Portal at HSConnectOnline.com. Cigna.com no longer supports the browser you are using. 2021 Medicare Provider Manual Cigna Medicare Advantage Providers in Arizona PCOMM-2021-1081-AZ 8/21 ARIZONA HEALTH CARE PROFESSIONALS PROVIDER MANUAL MEDICARE ADVANTAGE 2021 Page 2of 104 All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation. eviCore has a national network of providers who offer these services. Details Apr 14, 2023 Feedback Will open a new window hb``b``Ab,nF )H\g```h i~ a,g}]Ig]7 1fq61` v T ob!!|Fy JC that insure or administer group HMO, dental HMO, and other products or services in your state). 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. 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. Thank you for using eviCores website today! endobj All insurance policies and group benefit plans contain exclusions and limitations. However, these guidelines may not be applicable in certain clinical circumstances. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna. Provider manuals You will find guides to support you in providing care, managing your practice and working with us. endstream endobj startxref 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. <> a listing of the legal entities To find a participating provider, call eviCore at 800.298.4806 or go to Cigna.com > Find a Doctor. we will be implementing changes to evicore.com in the near future. CocoDoc has made it easier for people to Modify their important documents by online browser. Provider Reference Guide - Baylor Scott & White Health Plan After one year and prior to four years from the date of determination, "good cause" is required for Medicare to reopen the claim. Medical and Dental 1 (800) 88CIGNA (882-4462) Behavioral 1 (800) 926-2273 Pharmacy Email us The Cigna Group Information Disclaimer Visit the Provider Portal at HSConnectOnline.com. 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. Health care providers remain the endobj They can easily Tailorize through their choices. Were still hiring for other *The Silver&Fit program is provided by American Specialty Health Fitness, Inc., a subsidiary of American Specialty Health Incorporated (ASH). Silver&Fit is a registered trademark of ASH and used with permission herein. All insurance policies and group benefit plans contain exclusions and limitations. We take on the administrative burden so you can focus on getting patients the care they need, and get paid in a timely manner. %%EOF To make updates , please notify QualCare Provider Relations. Cigna does not control the linked sites' content or links. eviCore's clinical guidelines may include information inapplicable to benefit plans administered by Cigna. Copyright 2022 eviCore healthcare. From professional newsletters to wellness programs to Cigna medical plans and more, this is the medical health care professional's source for information. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna. 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. Q4: How can eviCore make it easier for you to use this website? All Rights Reserved. reCAPTCHA is not valid; Please try again! To know the process of editing PDF document or application across the online platform, you need to follow these . 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 We're here to help. 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. 128 0 obj <>stream 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. Cigna may not control the content or links of non-Cigna websites. %%EOF 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. 0 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. Q1: Overall, how satisfied are you with eviCores website? 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 5 0 obj Delivering medical providers with important news, including: Connecting Behavioral Health Care Providers with recent news. By using this site, you acknowledge that this material is copyrighted and agree to the terms and conditions noted above. 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. 2021 when submitted under Cigna commercial medical benefit plans. To learn more about a program, or request a patient eligibility evaluation, email CignaRefer_Help@Cigna.com. Read our quick-reference guide (PDF) Network participation criteria We have a set of criteria for participation in our provider network. Get Adobe Reader. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna. *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * It's best to submit claims as soon as possible. In order to have the best experience on Cigna.com, Javascript needs to be enabled. %PDF-1.5 % Clinicians are expected to use independent medical judgment which takes into account the clinical circumstances to make individual management decisions. For availability, costs and complete details of coverage, contact a licensed agent or Cigna sales representative. 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 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. a listing of the legal entities 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. 0 On January 1, 2023, eviCore began managing the provider network for orthotics and prosthetics (O&P) services for Cigna commercial customers. Clinical decisions, including treatment decisions, are the responsibility of the individual and his/her provider. eviCore positions. Encouraging patients to get vaccinated. Medicare patients' claims must be filed no later than the end of the calendar year following the year in which the services were provided. endstream endobj 59 0 obj <>>> endobj 60 0 obj <. guidelines at-a-glance flyer or visit our updated provider COVID-19 web page at CignaforHCP.com. This website is not intended for residents of New Mexico. Selecting these links will take you away from Cigna.com to another website, which may be a non-Cigna website. An initial determination on a previously adjudicated claim may be reopened for any reason for one year from the date of that determination. Beginning Friday, December 18th at 5:00pm EST, you eviCore is responsible for the following: The following table provides examples of eviCore-provided services. 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. Watch this presentation to learn more about cultural competence and the important role you play as a provider. Terms of Use | 4810 0 obj <> endobj 0 %PDF-1.6 % Find PA forms at MedicareProviders.Cigna.com > Forms and Practice Support > Prior Authorization Requirements. As of February 1, 2021, eviCore healthcare (eviCore) manages home health care, durable medical equipment (DME), and home infusion therapy for Cigna commercial customers. ka[|Ku@,OK"5HwC8UR10w%oF~O>?q8P y|Qge?6N$i@5@)Q \hRC-$J2RpjnPpS=ud7ofT& *FQQe^ afsTOln7ePX5@bGpF]$J\[R^5s=>nfL4f]_I>-!R|79@[Z6PVpd1*%FW0TCBGWP4|! If you have any questions or would like more information about participating in a Cigna health care network, please contact us. 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). 58 0 obj <> endobj E-Verify and IER Right to Work. 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 Cigna may not control the content or links of non-Cigna websites. Other names or logos may be trademarks of their respective owners. %PDF-1.7 % Message Here. To view or print these files, you must download and install the free Adobe Acrobat Reader. ?siuC~62Ovxy:5igu+aF7c ??S d\R|I@z t_5bXXSCp@ufjZPd~8 a}a?%Tz#fr]} )arE1/KP!}2HSY-=7! 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. Beginning on 3/15/21, web users will be required to log in to evicore.com in order to check the status Appeals and Disputes HIPAA Transaction Standards Questions? Cigna Medicare Advantage Plans . of authorization request(s). Helping you keep up with research, trends, and policy changes that impact your practice. that insure or administer group HMO, dental HMO, and other products or services in your state). Network Insider Medicare Provider Newsletter, Provider Portal Claimstat Login Arizona Providers Only, www.eviCore.com/Resources/Healthplan/Cigna-Medicare, www.eviCore/com/Provider/Clinical-Guidelines. 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. Good health and a good doctor/patient relationship begins with understanding your patients' cultural, ethnic, racial and linguistic needs. 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. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. All pictures are used for illustrative purposes only. If a resubmission is not a Cigna request, and is not being submitted as an appeal, the filing limit will apply. In addition to the RFI content , Cigna LifeSOURCE annually evaluates each transplant program to determine continued compliance with established guidelines . 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. &+3gdn WZ!'H7}k+Vai|F_*H|NW _[GJ[okazk4Rw3iR\_[Jn2Y{beL_ek^ax66Pwwz^Hm/(1WLdrJ|zGLDDh @`l"L@SbOD4 E V&74Z}? 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. 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 Enrollment in Oscar depends on contract renewal. hbbd``b` SK(La "$[" rD @Ua$"C 6#I#s Z hd|(3bECB!_,BM@2sjn&+_C+S3 kg|N0=8fx8P T! This website is not intended for residents of New Mexico. IMPORTANT: In the coming days, we will be migrating systems for our %-NM .t|p[!U"thV6I>sHH{[;:B#N v',(M=a!bHJ. 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
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