3250 0 obj <> endobj To search the Prior Authorization guide for a code, enter Ctrl+F > the 5-digit code. We are committed to ensuring that your participation in the QualCare network is a positive and beneficial experience. 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. Visit the Provider Portal at HSConnectOnline.com. Get Adobe Reader. 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. Selecting these links will take you away from CignaforHCP.com. If Medicare is the primary payer, timely filing is determined from the processing date indicated on the primary carrier's explanation of benefit (EOB). 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. Details. Medical and Dental 1 (800) 88CIGNA (882-4462) Behavioral 1 (800) 926-2273 Pharmacy Email us The Cigna Group Information Disclaimer Delivering medical providers with important news, including: Connecting Behavioral Health Care Providers with recent news. 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. Q4: How can eviCore make it easier for you to use this website? 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, 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. @ >9{$I@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@`t3186?;>YY_H@kukU%dL@3!7aPf47J@&2@#j8H8N YBiYB`h2052b4e"F GfCIUKF3L[e%,d Y gY")% y\ UP2 M|1B~ Whether you need to stay informed on Cigna policies, want to check out an informative webinar, or are looking for the latest news on Medicare, youll find it here with our newsletters, dedicated to keeping health care providers at the top of their game. Accidental Injury, Critical Illness, and Hospital Care plans or insurance policies are distributed exclusively by or through operating subsidiaries of Cigna Corporation, are administered by Cigna Health and Life Insurance Company, and are insured by either (i) Cigna Health and Life Insurance Company (Bloomfield, CT); (ii) Life Insurance Company of North America (LINA) (Philadelphia, PA); or (iii) New York Life Group Insurance Company of NY (NYLGICNY) (New York, NY), formerly known as Cigna Life Insurance Company of New York. Beginning Friday, December 18th at 5:00pm EST, you 4828 0 obj <>/Filter/FlateDecode/ID[<6BC9DFFB7467AF4AB407F2A14C4E167D><84593DD970E2D74EA4BE0EDE70F6ABF6>]/Index[4810 472]/Info 4809 0 R/Length 127/Prev 809539/Root 4811 0 R/Size 5282/Type/XRef/W[1 3 1]>>stream that insure or administer group HMO, dental HMO, and other products or services in your state). <> stream guidelines at-a-glance flyer or visit our updated provider COVID-19 web page at CignaforHCP.com. Message Here. % For Cigna Medicare membership guidelines click here. 0 ??S d\R|I@z t_5bXXSCp@ufjZPd~8 a}a?%Tz#fr]} )arE1/KP!}2HSY-=7! To make updates , please notify QualCare Provider Relations. 128 0 obj <>stream hbbd```b`:" l,3!V "@|j0$> 0L[+&00Fr G(9J'(9Ft5JJgx s When you have the right tools, you can give your patients the care they deserve. 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. There are some exceptions to these deadlines. 3 0 obj <> reCAPTCHA is not valid; Please try again! Provider Reference Guide - Baylor Scott & White Health Plan Need help? 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. ?siuC~62Ovxy:5igu+aF7c Using these recommended billing guidelines and codes will help facilitate proper reimbursement and help to avoid errors and potential reimbursement delays. Medicare patients' claims must be filed no later than the end of the calendar year following the year in which the services were provided. For availability, costs and complete details of coverage, contact a licensed agent or Cigna sales representative. Beginning on 3/15/21, web users will be required to log in to evicore.com in order to check the status Silver&Fit is a registered trademark of ASH and used with permission herein. For additional information about the Modifier 25 - Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service reimbursement policy please watch this brief video. endobj 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. 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. We're here to help. 3277 0 obj <>stream These guidelines are written to cover medical conditions as experienced by the majority of individuals. 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 As always, you can appeal denied claims if you feel an appeal is warranted. 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 Selecting these links will take you away from Cigna Medicare Advantage and Medicare Part D Prescription Drug Plan information. Cookies are not enabled, for best results please enable cookies. %%EOF This website is not intended for residents of New Mexico. endstream endobj startxref The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of 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. CocoDoc has made it easier for people to Modify their important documents by online browser. 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|! %PDF-1.4 Cigna.com no longer supports the browser you are using. Cigna may not control the content or links of non-Cigna websites. 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. Selecting these links will take you away from Cigna.com to another website, which may be a non-Cigna website. Thank you for the quality care you provide to our members. Please call QualCare Provider Relations at 800.992.6613 if you have any questions or concerns. 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. Use our self-service guidance and support form to easily find answers and resources for the most common inquiries. 1 0 obj They can easily Tailorize through their choices. 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 has a national network of providers who offer these services. hbbd``b` SK(La "$[" rD @Ua$"C 6#I#s Z This web site uses files in Adobe Acrobat Portable Document Format (PDF). Good health and a good doctor/patient relationship begins with understanding your patients' cultural, ethnic, racial and linguistic needs. 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 Copyright 2022 eviCore healthcare. hTkSW?%yy$^5%VS&`Zc/JPZi(t45?lM.X Vb!1ZP&V8f[_2r}Iss/ 0S3UU%j9(UTT ( To order eviCore-provided services for your patients with Cigna-administered coverage, contact a participating provider. Clinical decisions, including treatment decisions, are the responsibility of the individual and his/her provider. 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. Clinicians are expected to use independent medical judgment which takes into account the clinical circumstances to make individual management decisions. All material on this website is, unless otherwise stated, the property of eviCore healthcare. By using this site, you acknowledge that this material is copyrighted and agree to the terms and conditions noted above. 5281 0 obj <>stream The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna. 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. To submit a Prior Authorization request:Visit the Provider Portal at HSConnectOnline.com. of authorization request(s). If Medicare is the Secondary Payer (MSP), the initial claim must be submitted to the primary payer within Cigna's timely filing period. 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'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. eviCore made it easy to complete my primary task online. ALL RIGHTS RESERVED. These guidelines apply to Cigna Medicare Advantage customers. that insure or administer group HMO, dental HMO, and other products or services in your state). 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/ Enrollment in Cigna depends on contract renewal. If a resubmission is not a Cigna request, and is not being submitted as an appeal, the filing limit will apply. To find a participating provider, call eviCore at 800.298.4806 or go to Cigna.com > Find a Doctor. An initial determination on a previously adjudicated claim may be reopened for any reason for one year from the date of that determination. To learn more about a program, or request a patient eligibility evaluation, email CignaRefer_Help@Cigna.com. endstream endobj startxref As of February 1, 2021, eviCore healthcare (eviCore) manages home health care, durable medical equipment (DME), and home infusion therapy for Cigna commercial customers. vaccine, please review our . <> providers according to plan rules as listed in the online provider manual. %-NM .t|p[!U"thV6I>sHH{[;:B#N v',(M=a!bHJ. This website is not intended for residents of New Mexico. In addition to the RFI content , Cigna LifeSOURCE annually evaluates each transplant program to determine continued compliance with established guidelines . %PDF-1.5 % 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). 5 0 obj x}s[}5@IN[I;eo2'u:MOmD$EYjmv:lGRh8Y*Ix\2;v#uc7M:t?ps. 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. Cigna Medicare Advantage Plans . hbbd```b``kd d im "YC'`S`q{4.F wHeg`bdq m#@g l< IMPORTANT: In the coming days, we will be migrating systems for our cigna commercial provider manual 2021; How to Easily Edit Cigna Billing Manual Form Online. To know the process of editing PDF document or application across the online platform, you need to follow these . However, these guidelines may not be applicable in certain clinical circumstances. Oscar is an HMO with a Medicare contract. 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. 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). Committed to cultural competency. 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. Thank you for using eviCores website today! Member Rights Policy | 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. 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 We take on the administrative burden so you can focus on getting patients the care they need, and get paid in a timely manner. You may save, download and print these guides for use in your office. Copyright and other intellectual property laws protect these materials. that insure or administer group HMO, dental HMO, and other products or services in your state). Ethics & Compliance | In order to have the best experience on Cigna.com, Javascript needs to be enabled. For additional information on our coverage and reimbursement of the COVID-19. 4810 0 obj <> endobj 2021 when submitted under Cigna commercial medical benefit plans. Q1: Overall, how satisfied are you with eviCores website? Terms of Use | Annual Utilization Statistics | 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? 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. 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 insurance policies and group benefit plans contain exclusions and limitations. 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. eviCore has a national network of providers who offer these services. Updates to Cigna's policies and procedures, Announcements of new Cigna electronic tools and services, Clinical, pharmacy, and Medicare Advantage updates. 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.

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