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. Cigna may not control the content or links of non-Cigna websites. 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. You may save, download and print these guides for use in your office. For Cigna Medicare membership guidelines click here. If you have any questions or would like more information about participating in a Cigna health care network, please contact us. 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. Clinicians are expected to use independent medical judgment which takes into account the clinical circumstances to make individual management decisions. hbbd```b``kd d im "YC'`S`q{4.F wHeg`bdq m#@g l< hb```, cb@1FFAA/j8Dcj29vPh 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 Using these recommended billing guidelines and codes will help facilitate proper reimbursement and help to avoid errors and potential reimbursement delays. 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. Provider customer service 1.800.230.6138 Provider website MedicareProviders.Cigna.com Provider manual MedicareProviders.Cigna.com > 2023 Provider Manual ID card examples MedicareProviders.Cigna.com > 2023 Provider Manual > 2023 Customer Identification Cards Provider portal HSConnectOnline.com Help Desk: 1.866.952.7596 Email: HSConnectHelp@ Q4: How can eviCore make it easier for you to use this website? When you have the right tools, you can give your patients the care they deserve. Cigna does not control the linked sites' content or links. Beginning on 3/15/21, web users will be required to log in to evicore.com in order to check the status Clinical decisions, including treatment decisions, are the responsibility of the individual and his/her provider. <> We are committed to ensuring that your participation in the QualCare network is a positive and beneficial experience. ?siuC~62Ovxy:5igu+aF7c endstream endobj 59 0 obj <>>> endobj 60 0 obj <. endstream endobj startxref Report Fraud & Abuse | Details. 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, 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 3277 0 obj <>stream 128 0 obj <>stream 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. 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. If Medicare is the primary payer, timely filing is determined from the processing date indicated on the primary carrier's explanation of benefit (EOB). Health care providers remain the x}s[}5@IN[I;eo2'u:MOmD$EYjmv:lGRh8Y*Ix\2;v#uc7M:t?ps. 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. Cigna.com no longer supports the browser you are using. 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. Provider manuals You will find guides to support you in providing care, managing your practice and working with us. Helping you keep up with research, trends, and policy changes that impact your practice. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna. To find a participating provider, call eviCore at 800.298.4806 or go to Cigna.com > Find a Doctor. of authorization request(s). 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. Find PA forms at MedicareProviders.Cigna.com > Forms and Practice Support > Prior Authorization Requirements. vaccine, please review our . As a valued user of our website, wed appreciate your feedback to help us improve your website experience. As of February 1, 2021, eviCore healthcare (eviCore) manages home health care, durable medical equipment (DME), and home infusion therapy for Cigna commercial customers. 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). %PDF-1.6 % @ >9{$I@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@`t3186?;>YY_H@kukU%dL@3!7aPf47J@&2@#j8H8N YBiYB`h2052b4e"F GfCIUKF3L[e%,d Y gY")% y\ UP2 M|1B~ *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * E-Verify and IER Right to Work. 5281 0 obj <>stream a listing of the legal entities Annual Utilization Statistics | Updates to Cigna's policies and procedures, Announcements of new Cigna electronic tools and services, Clinical, pharmacy, and Medicare Advantage updates. that insure or administer group HMO, dental HMO, and other products or services in your state). Delivering medical providers with important news, including: Connecting Behavioral Health Care Providers with recent news. Cigna Medicare Advantage Plans . hbbd``b` SK(La "$[" rD @Ua$"C 6#I#s Z hbbd```b`:" l,3!V "@|j0$> 0L[+&00Fr G(9J'(9Ft5JJgx s 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. For availability, costs and complete details of coverage, contact a licensed agent or Cigna sales representative. <> 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. 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. Get Adobe Reader. we will be implementing changes to evicore.com in the near future. 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. that insure or administer group HMO, dental HMO, and other products or services in your state). Committed to cultural competency. Ethics & Compliance | 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. 58 0 obj <> endobj To view or print these files, you must download and install the free Adobe Acrobat Reader. ??S d\R|I@z t_5bXXSCp@ufjZPd~8 a}a?%Tz#fr]} )arE1/KP!}2HSY-=7! that insure or administer group HMO, dental HMO, and other products or services in your state). Oscar is an HMO with a Medicare contract. Selecting these links will take you away from Cigna.com to another website, which may be a non-Cigna website. 1 Cigna may request appropriate evidence of extraordinary circumstances that prevented timely submission (e.g., natural disaster). Selecting these links will take you away from Cigna Medicare Advantage and Medicare Part D Prescription Drug Plan information. Copyright 2022 eviCore healthcare. %PDF-1.7 % To search the Prior Authorization guide for a code, enter Ctrl+F > the 5-digit code. 0 Enrollment in Oscar depends on contract renewal. endstream endobj 4811 0 obj <. Enrollment in Cigna depends on contract renewal. They can easily Tailorize through their choices. After one year and prior to four years from the date of determination, "good cause" is required for Medicare to reopen the claim. 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. All insurance policies and group benefit plans contain exclusions and limitations. 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. 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. There are some exceptions to these deadlines. 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 Cigna may not control the content or links of non-Cigna websites. 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. 3269 0 obj <>/Filter/FlateDecode/ID[<2E60FC638041A04290D8E725F3905F1C>]/Index[3250 28]/Info 3249 0 R/Length 99/Prev 521572/Root 3251 0 R/Size 3278/Type/XRef/W[1 3 1]>>stream Beginning Friday, December 18th at 5:00pm EST, you If you're unable to file a claim right away, please make sure the claim is submitted accordingly. Read our quick-reference guide (PDF) Network participation criteria We have a set of criteria for participation in our provider network. 1 (800) 668-3813 (TTY 711) 8:00 am 8:00 pm your local time, 7 days a week (Messaging service used weekends, after hours, and Federal holidays from . %%EOF 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|! cigna commercial provider manual 2021; How to Easily Edit Cigna Billing Manual Form Online. 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. 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 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). CocoDoc has made it easier for people to Modify their important documents by online browser. 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). If Medicare is the Secondary Payer (MSP), the initial claim must be submitted to the primary payer within Cigna's timely filing period. % In general, Medicare does not consider a situation where (a) Medicare processed a claim in accordance with the information on the claim form and consistent with the information in the Medicare's systems of records and; (b) a third party mistakenly paid primary when it alleges that Medicare should have been primary to constitute "good cause" to reopen. 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/ 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 For additional information on our coverage and reimbursement of the COVID-19. All material on this website is, unless otherwise stated, the property of eviCore healthcare. 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. To order eviCore-provided services for your patients with Cigna-administered coverage, contact a participating provider. We take on the administrative burden so you can focus on getting patients the care they need, and get paid in a timely manner. Provider Reference Guide - Baylor Scott & White Health Plan 3 0 obj 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 providers according to plan rules as listed in the online provider manual. 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. eviCore made it easy to complete my primary task online. 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.