Better health Were in it together LAKELAND CARE

Better health. We’re in it together. LAKELAND CARE October 16, 2019 Tools to make your life easier Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2019 Cigna

Better health. We’re in it together. CLAIMS 101 Tips for filing a claim Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2019 Cigna

How to submit claims to Cigna You can submit your claims to Cigna electronically, including coordination of benefits (COB) claims. • Use Cigna Payer ID 62308 to file medical, behavioral (including employee assistance program), dental, and Cigna-Health. Spring claims • Submit electronic claims directly to Cigna using the Post-n. Track® web service. Enroll for this free, easy to use service at www. Post-n-Track. com/Cigna • File claims electronically through an EDI vendor if you prefer to have a third party submit your claims to Cigna. Visit www. Cigna. com/EDIvendors for a list of vendors. Cigna accepts paper claims, however, we strongly encourage you to submit claims electronically. For more information on how to submit claims to Cigna and a link to the appropriate forms, visit Cigna. com (Resources for Health Care Professionals > Doing Business with Cigna > How to Submit Claims to Cigna). Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2019 Cigna

Payer Solutions: Third-party administrators Cigna contracts with third-party administrators (TPAs), selected insurers, and claim administrators (referred to collectively as “payers”) to share the administration of self -funded Administrative Services Only (ASO) plans. We also contract with several insurance companies that issue individual and group insurance policies. For these relationships, we: – provide access to our network – perform medical management and utilization reviews – re-price claims according to our contracted rates and claims logic – provide clinical appeals management – provide contract dispute resolution TPAs and insurance companies: • maintain eligibility • administer benefits • pay claims for these shared accounts on their own systems Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2019 Cigna

Payer Solutions: points of interaction Claim flow: • Claims should be submitted to Cigna (payer ID 62308 or to the claims mailing address on the patient’s ID card • Cigna prices the claims based on the network contracted rates • The priced claim is then forwarded to the payer for payment based on the patient’s eligibility and benefits • The payers then remit payment following contractually agreed upon turnaround requirements Clinical and contract-related appeals: • Appeals of clinical denials should be sent to Cigna using the contact information supplied in the denial letter(s) • Appeals of application of contract rates should go to the address on the patient’s ID card Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2019 Cigna Contact the payer* for: • • • Eligibility Benefits Precertification Claims status Non-pricing appeals * The contact phone number is located on the patient’s ID card Contact Cigna* for: • • • Reimbursement issues Pricing appeals General contract questions * The contact phone number for Cigna is 1. 888. 663. 8081

Better health. We’re in it together. APPEALS 101 Tips for filing an appeal Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2019 Cigna

Appeal prevention tips Avoid having to file an appeal. There are steps you can take to avoid having to file an appeal: – Confirm the plan information on the patient’s ID card matches your contract (e. g. , PPO, Open Access Plus, Network POS). – Verify benefits by asking clarifying questions to confirm if the procedure or CPT® code is covered under the plan, and that you have met all plan requirements for coverage. – Check the Cigna for Health Care Professionals website at Cignafor. HCP. com to confirm conditions for coverage based upon the medical criteria outlined. – Verify precertification requirements. – Refer patients to Cigna-participating providers. Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2019 Cigna

Appeal process Cigna strives to informally resolve issues raised by providers on initial contact whenever possible. If issues cannot be resolved informally: • Cigna offers a single-level, internal appeal process to resolve contractual disputes regarding post-service payment denials and payment disputes. Processes may vary due to state mandates or contract provisions. • The appeal must be initiated in writing within 180 calendar days of the date of the initial payment or denial decision. • Arbitration may be used as a final resolution step after the internal Cigna process is complete. Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2019 Cigna

Better health. We’re in it together. PROVIDER DIGITAL SOLUTIONS Tools to make your life easier Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2019 Cigna

EFT: Cigna’s required standard payment method Effective January 2017, EFT is Cigna’s required standard method for providers to receive reimbursements. All providers and facilities must enroll. Enrolling for EFT is easy If you’re already enrolled for Cigna EFT payments, you’re all set – there’s nothing more you need to do. Otherwise, you must enroll using one of the methods below: Cigna for Health Care Professionals website (Cignafor. HCP. com) – Enroll in EFT directly with Cigna by logging in to Cignafor. HCP. com > Working with Cigna > Enroll in Electronic Funds Transfer (EFT) Council for Affordable Quality Healthcare® (CAQH) – Enroll in EFT and manage EFT accounts with multiple payers, including Cigna, using the CAQH Solutions Enroll. Hub® at Solutions. CAQH. org Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2019 Cigna

Information. Delivered. Cigna for Health Care Professionals website (Cignafor. HCP. com) • Patient Information and Transactions – Eligibility and benefits – Patient out-of-pocket cost estimation (medical, behavioral) – Precertification submission and inquiry (medical) – Claims status inquiry – Electronic funds transfer enrollment and management – Remittance reports • Resources – e. Courses – Cigna formularies/drug list – ID cards – Clinical reimbursement and payment policies – Forms – Reference guides Trading Partners/EDI Vendors HIPAA 5010 transactions – Eligibility and benefits inquiry and response (270/271) – Health service review/precertification (278) – Electronic claim submission (837) – Claim acknowledgement (277 CA) – Claims status inquiry and response (276/277) – Electronic remittance advice (835) – Patient out of pocket cost estimation (Availity only) – Electronic funds transfer enrollment and management (CAQH only) Transaction availability varies by partner/vendor. For more information, visit Cigna. com/EDIvendors. Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2019 Cigna

Precertification • Check the back of the patient’s ID card or Cignafor. HCP. com > Resources > Clinical Reimbursement Policies and Payment Policies > Precertification Policies for coverage and precertification requirements. The website will have the most up-to-date information. • Submit requests for elective procedures at least 72 hours before the scheduled service. For patients with Cigna ID cards: – Log in to Cignafor. HCP. com > Patients > View & Submit Precertifications, or – Call 800. 88 Cigna (882. 4462) For patients with GWH-Cigna or “G” ID cards: – Call 866. 494. 2111 – All changes and updates to precertification can be viewed by logging in to Cignafor. HCP. com > Resources > Clinical Reimbursement Policies and Payment Policies > Precertification Policies The referring physician is responsible for obtaining approval for all services that require precertification prior to services being rendered. Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2019 Cigna 12

Better health. We’re in it together. NATIONAL ANCILLARY PROGRAMS Lowering costs without sacrificing quality Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2019 Cigna

providing your patients with quality and cost-effective care Accessible Quality focused Cost efficient Patient oriented 20% decrease in unnecessary radiology procedures 1 National Ancillary Programs* Service National ancillary providers* Dialysis • Davita • Fresenius Durable medical equipment, home health care, infusion therapy Care. Centrix Hearing Amplifon Hearing Health Care High-technology radiology and diagnostic cardiology evi. Core healthcare Integrated Oncology Management Program evi. Core healthcare Laboratory** • Lab. Corp® • Quest Diagnostics® Musculoskeletal and pain management evi. Core healthcare Orthotics and prosthetics Linkia Radiation therapy evi. Core healthcare Sleep management services 45%– 80% savings with national Vision labs services over other lab services 2 *List is not all-inclusive of every national ancillary provider. Ancillary providers do not manage services in all states and markets. **We currently contract with numerous local and national laboratories, including Lab. Corp® and Quest Diagnostics, Inc. and other reference, pathology, genetic, and esoteric labs, to provide quality laboratory services at in-network, cost-effective rates. Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2019 Cigna Care. Centrix 45%– 50% savings Up to $50, 000 per on total case savings using Vision Services Plan chiropractic costs 4 in-network outpatient dialysis facilty 3

Better health. We’re in it together. RESOURCES Tools to make your life easier Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2019 Cigna

Contacts and support • Webinars Cignafor. HCP. com > Resources > Medical Resources > Communications > Webinars for Health Care Professionals, or log in to Cignafor. HCP. com > Latest Updates • General Digital Solutions product information Cignafor. HCP. com > Resources > Medical Resources > Doing Business with Cigna > Digital Solutions • e. Courses and video tutorials Cignafor. HCP. com > Resources > Medical Resources and Training • EFT payment calendars Cignafor. HCP. com > Resources > Reimbursement & Payment Policies > Reimbursement • Your EDI vendor Don’t have an EDI vendor? Visit Cigna. com/EDIvendors for more information • 1. 800. 88 Cigna • Quarterly Network Newsletter: email Network. News. Editor@cigna. com to be added to the distribution listewsgna. com to be • Lauren Koons: lauren. koons@cigna. com / 860. 787. 6847 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2019 Cigna your resources your way