5 0 obj This website is not intended for residents of New Mexico. Cigna does not control the linked sites' content or links. 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). 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. 3277 0 obj <>stream 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. %PDF-1.6 % <> Use our self-service guidance and support form to easily find answers and resources for the most common inquiries. To submit a Prior Authorization request:Visit the Provider Portal at HSConnectOnline.com. Message Here. By using this site, you acknowledge that this material is copyrighted and agree to the terms and conditions noted above. endstream endobj startxref As a valued user of our website, wed appreciate your feedback to help us improve your website experience. 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? This website is not intended for residents of New Mexico. Clinical decisions, including treatment decisions, are the responsibility of the individual and his/her provider. 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 of authorization request(s). guidelines at-a-glance flyer or visit our updated provider COVID-19 web page at CignaforHCP.com. vaccine, please review our . Beginning Friday, December 18th at 5:00pm EST, you Cigna.com no longer supports the browser you are using. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna. Details Apr 14, 2023 Feedback Will open a new window *The Silver&Fit program is provided by American Specialty Health Fitness, Inc., a subsidiary of American Specialty Health Incorporated (ASH). Q1: Overall, how satisfied are you with eviCores website? a listing of the legal entities endstream endobj 4811 0 obj <. 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. 4810 0 obj <> endobj 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. 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. 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 This is useful for forms that you want to view and/or print. 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. An initial determination on a previously adjudicated claim may be reopened for any reason for one year from the date of that determination. 1 0 obj Report Fraud & Abuse | Please click here to register for an account. 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. hTkSW?%yy$^5%VS&`Zc/JPZi(t45?lM.X Vb!1ZP&V8f[_2r}Iss/ 0S3UU%j9(UTT ( Cigna may not control the content or links of non-Cigna websites. 1 Cigna may request appropriate evidence of extraordinary circumstances that prevented timely submission (e.g., natural disaster). You may save, download and print these guides for use in your office. In order to have the best experience on Cigna.com, Javascript needs to be enabled. If you're unable to file a claim right away, please make sure the claim is submitted accordingly. Selecting these links will take you away from CignaforHCP.com. 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. Request a Consultation with a Clinical Peer Reviewer, Check Status Of Existing Prior Authorization, Check Status of Existing Prior Authorization, Computed Tomography (CT) and Computed Tomography Angiography (CTA), Magnetic Resonance Imaging (MRI) and Magnetic Resonance Angiography (MRA), The terms of the applicable coverage plan document in effect on the date of service, Any relevant collateral source materials including clinical guidelines, The specific facts of the particular situation. To view or print these files, you must download and install the free Adobe Acrobat Reader. Beginning on 3/15/21, web users will be required to log in to evicore.com in order to check the status ??S d\R|I@z t_5bXXSCp@ufjZPd~8 a}a?%Tz#fr]} )arE1/KP!}2HSY-=7! If Medicare is the Secondary Payer (MSP), the initial claim must be submitted to the primary payer within Cigna's timely filing period. Appeals and Disputes HIPAA Transaction Standards Questions? Q4: How can eviCore make it easier for you to use this website? Additional clinical guidelines may be developed as needed or may be withdrawn from use. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna. 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). 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 58 0 obj <> endobj When you have the right tools, you can give your patients the care they deserve. Get Adobe Reader. 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, a listing of the legal entities Medical and Dental 1 (800) 88CIGNA (882-4462) Behavioral 1 (800) 926-2273 Pharmacy Email us The Cigna Group Information Disclaimer If a resubmission is not a Cigna request, and is not being submitted as an appeal, the filing limit will apply. 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. 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. Oscar is an HMO with a Medicare contract. Thank you for the quality care you provide to our members. 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. In addition to the RFI content , Cigna LifeSOURCE annually evaluates each transplant program to determine continued compliance with established guidelines . 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. It's best to submit claims as soon as possible. ALL RIGHTS RESERVED. 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). 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. reCAPTCHA is not valid; Please try again! %PDF-1.5 % Details. If a claim was timely filed originally, but Cigna requested additional information. 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. Enrollment in Oscar depends on contract renewal. endobj Helping you keep up with research, trends, and policy changes that impact your practice. 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. cigna commercial provider manual 2021; How to Easily Edit Cigna Billing Manual Form Online. 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 0 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.
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