LAKELAND CARE PAYER CONFERENCE OCTOBER 19 2016 VERIFYING

LAKELAND CARE PAYER CONFERENCE OCTOBER 19, 2016

VERIFYING ELIGIBILITY Verify eligibility: You can change the date to view eligibility & benefits for up to 2 years in the past, or up to 30 days in the future. • cignaforhcp. com • Multi-Payer Websites such as Navi. Net • Customer Service: 800. 88 Cigna (882. 4462) Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna 2

VERIFYING ELIGIBILITY & BENEFITS Scroll to view benefits by medical category cignaforhcp. com Obtain patient eligibility Estimate costs View benefits by medical category View claims Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna 3

PRECERTIFICATION Cigna’s outpatient precertification list is available to download at cignaforhcp. com > Resources > Clinical Reimbursement & Payment Policies > Precertification If you are logged into cignaforhcp. com, you will be prompted to accept Navi. Net’s privacy policies and a new window will appear so you can begin precertification. Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna 4

HIGH TECH RADIOLOGY & MUSCULOSKELETAL PRECERTIFICATION Cigna works with evi. Core healthcare (formerly Med Solutions) to administer a precertification program for the following high tech radiology and musculoskeletel services. Precertification is required through evi. Core healthcare for the following services: CT/CTA MRI/MRA PET Interventional Pain Management Nuclear cardiology imaging Stress echocardiogram Diagnostic left and right heart catheterization Major joint surgery (hip, knee, shoulder) Precertification can be requested in one of three ways: Ø Ø Ø Online: myportal. medsolutions. com Phone: (888) 693 -3297 (8: 00 am – 9: 00 pm EST) Fax: (888) 693 -3210 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna 5

CLAIM SUBMISSION > Cigna encourages electronic claim submission using Cigna Payer ID 62308 – COB claims: Submit primary and secondary (COB) claims electronically using loops 2320 and 2330. You don’t have to submit Medicare Part A and Part B coordination of benefits agreement (COBA) claims to us. The Medicare EOB or ERA will show that those claims have been forwarded to us as the secondary payer. – Corrected claims: Use the Claim Frequency Type Code in loop 2300, segment CLM 05, to specify the frequency of the claim (this is the third position of the UB 04 bill type) – Use one of the following codes to indicate the claim type: 1 – Original (admit through discharge claim) 7 – Replacement (of a prior claim), include Payer Claim Control # in segment REF*F 8 9 – Void (or cancellation of prior claim), include Payer Claim Control # in segment REF*F 8 When a corrected claim is submitted, you will receive a “duplicate to claim already in process” denial message and the corrections will be applied to the original claim. Ø Claim Mailing Address: PO Box 188061, Chattanooga, TN 37422 -8061 Ø Cigna primary claims must be submitted within 180 days of the date of service. Secondary claims must be submitted within 180 days of the receipt of the primary payers EOB. Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna 6

APPEAL SUBMISSION Appeals: Ø Cigna offers a single-level appeal process. Appeals must be initiated within 180 calendar days of the date of the initial payment or denial decision. Ø Decisions are made and communicated within 60 days of receipt of the appeal. Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2014 Cigna 7

EXAMPLE ID CARD Ø Cigna ID cards list the plan type and any copay on the right-hand side. The back of the card contains contact information, claim submission guidelines and precertification requirements. Ø Please use cignaforhcp. com for deductible and coinsurance. Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna 8

COST OF CARE ESTIMATOR Cost of Care Estimator: Provides an itemized estimate for specific services. Shows the patient’s out of pocket expenses based on their plan. Helps facilitate financial discussions between you and your patients. Select PRINT PATIENT ESTIMATE to print a copy for the patient. Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna 9

COACH BY CIGNA Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2014 Cigna 10

QUESTIONS Thank you, Lauren Koons (860) 787 -6847 lauren. koons@cigna. com