hbbd``b` SK(La "$[" rD @Ua$"C 6#I#s Z Annual Utilization Statistics | PDF 2021 Medicare Provider Manual Cigna Medicare Advantage Providers in Arizona 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. Thank you for the quality care you provide to our members. endstream endobj startxref 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 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). 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. 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. <> Selecting these links will take you away from Cigna.com to another website, which may be a non-Cigna website. All insurance policies and group benefit plans contain exclusions and limitations. PDF IMPORTANT INFORMATION FROM CIGNA - Maryland.gov Enterprise Agency Template Clinical decisions, including treatment decisions, are the responsibility of the individual and his/her provider. we will be implementing changes to evicore.com in the near future. As always, you can appeal denied claims if you feel an appeal is warranted. &+3gdn WZ!'H7}k+Vai|F_*H|NW _[GJ[okazk4Rw3iR\_[Jn2Y{beL_ek^ax66Pwwz^Hm/(1WLdrJ|zGLDDh @`l"L@SbOD4 E V&74Z}? that insure or administer group HMO, dental HMO, and other products or services in your state). We're here to help. To search the Prior Authorization guide for a code, enter Ctrl+F > the 5-digit code. Quick Reference Guide | Cigna Medicare Providers hb```, cb@1FFAA/j8Dcj29vPh Copyright and other intellectual property laws protect these materials. Appeals and Disputes HIPAA Transaction Standards Questions? <> stream 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. Please call QualCare Provider Relations at 800.992.6613 if you have any questions or concerns. Additional clinical guidelines may be developed as needed or may be withdrawn from use. @ >9{$I@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@`t3186?;>YY_H@kukU%dL@3!7aPf47J@&2@#j8H8N YBiYB`h2052b4e"F GfCIUKF3L[e%,d Y gY")% y\ UP2 M|1B~ See the criteria (PDF) Office manual for health care professionals wont be able to apply to eviCore openings. Change Healthcare/Availity (Payor ID: 63092 or 52192), SSIGroup/Proxymed/Medassets/Zirmed/OfficeAlly/GatewayEDI (Payor ID: 63092), Relay Health (Professional claims CPID: 2795 or 3839, Institutional claims CPID: 1556 or 1978). PDF COVID-19 MEDICARE ADVANTAGE BILLING & AUTHORIZATION GUIDELINES - Cigna If a resubmission is not a Cigna request, and is not being submitted as an appeal, the filing limit will apply. hTkSW?%yy$^5%VS&`Zc/JPZi(t45?lM.X Vb!1ZP&V8f[_2r}Iss/ 0S3UU%j9(UTT ( PDF Provider Quick Reference Guide - Cigna You may save, download and print these guides for use in your office. Please click here to register for an account. Medical and Dental 1 (800) 88CIGNA (882-4462) Behavioral 1 (800) 926-2273 Pharmacy Email us The Cigna Group Information Disclaimer All Rights Reserved. If services are rendered on consecutive days, such as for a hospital confinement, the limit will be counted from the last date of service. 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. Health Care Provider Newsletters | Cigna endstream endobj 4811 0 obj <. We are committed to ensuring that your participation in the QualCare network is a positive and beneficial experience. 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. Ethics & Compliance | 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/ 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 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. ALL RIGHTS RESERVED. Health care providers remain the eviCore positions. This is useful for forms that you want to view and/or print. ??S d\R|I@z t_5bXXSCp@ufjZPd~8 a}a?%Tz#fr]} )arE1/KP!}2HSY-=7! Visit the Provider Portal at HSConnectOnline.com. By using this site, you acknowledge that this material is copyrighted and agree to the terms and conditions noted above. endobj When to File Claims | Cigna 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. endobj If you have any questions or would like more information about participating in a Cigna health care network, please contact us. 1 Cigna may request appropriate evidence of extraordinary circumstances that prevented timely submission (e.g., natural disaster). that insure or administer group HMO, dental HMO, and other products or services in your state). 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. Keeping Dental Health providers up to date. hb``b``Ab,nF )H\g```h i~ a,g}]Ig]7 1fq61` v T ob!!|Fy JC Cigna | eviCore For availability, costs and complete details of coverage, contact a licensed agent or Cigna sales representative. PDF QANI Reference Guide for physicians, hospitals, ancillaries, and other 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 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. %PDF-1.4 Beginning on 3/15/21, web users will be required to log in to evicore.com in order to check the status 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. % 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 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 We take on the administrative burden so you can focus on getting patients the care they need, and get paid in a timely manner. Clinicians are expected to use independent medical judgment which takes into account the clinical circumstances to make individual management decisions. 0 After one year and prior to four years from the date of determination, "good cause" is required for Medicare to reopen the claim. Read our quick-reference guide (PDF) Network participation criteria We have a set of criteria for participation in our provider network. 3277 0 obj <>stream 0 3250 0 obj <> endobj 2021 when submitted under Cigna commercial medical benefit plans. To submit a Prior Authorization request:Visit the Provider Portal at HSConnectOnline.com. %PDF-1.6 % Cigna does not control the linked sites' content or links. Delivering medical providers with important news, including: Connecting Behavioral Health Care Providers with recent news. Is Cigna insurance a PPO or HMO? - Byutiful.net 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 Silver&Fit is a registered trademark of ASH and used with permission herein. 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). Selecting these links will take you away from Cigna.com to another website, which may be a non-Cigna website. %%EOF of authorization request(s). Selecting these links will take you away from Cigna.com to another website, which may be a non-Cigna website. 0 Medicare patients' claims must be filed no later than the end of the calendar year following the year in which the services were provided. This website is not intended for residents of New Mexico. Selecting these links will take you away from CignaforHCP.com. Details Apr 14, 2023 Feedback Will open a new window Cigna.com no longer supports the browser you are using. Copyright 2022 eviCore healthcare. These guidelines apply to Cigna Medicare Advantage customers. 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. 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. Q4: How can eviCore make it easier for you to use this website? For Cigna Medicare membership guidelines click here. 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. 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 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 From professional newsletters to wellness programs to Cigna medical plans and more, this is the medical health care professional's source for information. All insurance policies and group benefit plans contain exclusions and limitations. 6T O'@j8*r', ;#Na-16|=i8IO_K$ _v:s+)"{%#YdQA=2A`,?6P~<4?EE`GD*8j 5pg, =dn/G~5i/!,A1R5n12&A{@ &`" _X)Z$K:PQ84H&TiXh|eOJDK E@0Rkg,_c"3?KpmJT. Beginning Friday, December 18th at 5:00pm EST, you PDF Cigna Medicare Advantage Plans Cigna Medicare Advantage Plans (Arizona providers according to plan rules as listed in the online provider manual. 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. %-NM .t|p[!U"thV6I>sHH{[;:B#N v',(M=a!bHJ. Using these recommended billing guidelines and codes will help facilitate proper reimbursement and help to avoid errors and potential reimbursement delays. cigna commercial provider manual 2021; How to Easily Edit Cigna Billing Manual Form Online. In order to have the best experience on Cigna.com, Javascript needs to be enabled. For availability, costs and complete details of coverage, contact a licensed agent or Cigna sales representative. As a valued user of our website, wed appreciate your feedback to help us improve your website experience. 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. CHCP - Resources - Medical Reference Guides - Cigna All material on this website is, unless otherwise stated, the property of eviCore healthcare. Provider manuals - Aetna Cigna may not control the content or links of non-Cigna websites. All insurance policies and group benefit plans contain exclusions and limitations. Need help? CHCP - Resources - Cigna's response to COVID-19 eviCore's clinical guidelines may include information inapplicable to benefit plans administered by Cigna. Watch this presentation to learn more about cultural competence and the important role you play as a provider. All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. All pictures are used for illustrative purposes only. Coverage and Claims | Cigna Message Here. 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. If Medicare is the Secondary Payer (MSP), the initial claim must be submitted to the primary payer within Cigna's timely filing period. Enrollment in Cigna depends on contract renewal. hbbd```b``kd d im "YC'`S`q{4.F wHeg`bdq m#@g l< Cigna Billing Manual Form: Fillable, Printable & Blank PDF Form for Cookies are not enabled, for best results please enable cookies. a listing of the legal entities Encouraging patients to get vaccinated. CHCP - Resources - Clinical Reimbursement Policies and Payment - Cigna CHCP - Resources - Reference Guides - Cigna Cigna may not control the content or links of non-Cigna websites. 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. Provider Resources - hioscar.com Cultural competency training video. It's best to submit claims as soon as possible. a listing of the legal entities Member Rights Policy | Selecting these links will take you away from Cigna Medicare Advantage and Medicare Part D Prescription Drug Plan information. 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. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna. 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