cigna commercial provider manual 2021

Using these recommended billing guidelines and codes will help facilitate proper reimbursement and help to avoid errors and potential reimbursement delays. Health care providers remain the On January 1, 2023, eviCore began managing the provider network for orthotics and prosthetics (O&P) services for Cigna commercial customers. Report Fraud & Abuse | All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation. As a valued user of our website, wed appreciate your feedback to help us improve your website experience. cigna commercial provider manual 2021; How to Easily Edit Cigna Billing Manual Form Online. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna. 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, reCAPTCHA is not valid; Please try again! Clinical decisions, including treatment decisions, are the responsibility of the individual and his/her provider. endstream endobj 59 0 obj <>>> endobj 60 0 obj <. 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. Additional clinical guidelines may be developed as needed or may be withdrawn from use. %PDF-1.5 % we will be implementing changes to evicore.com in the near future. To make updates , please notify QualCare Provider Relations. To search the Prior Authorization guide for a code, enter Ctrl+F > the 5-digit code. Selecting these links will take you away from Cigna.com to another website, which may be a non-Cigna website. Member Rights Policy | Privacy Policy | All insurance policies and group benefit plans contain exclusions and limitations. If a resubmission is not a Cigna request, and is not being submitted as an appeal, the filing limit will apply. 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). %%EOF However, the filing limit is extended another full year if the service was provided during the last three months of the calendar year. 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). Medical technology is continuously evolving; the guidelines undergo a formal review annually, however eviCore reserves the right to change and update the guidelines without prior notice. 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 does not control the linked sites' content or links. 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. 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 0 %PDF-1.4 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. endobj 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 . 0 1 0 obj &+3gdn WZ!'H7}k+Vai|F_*H|NW _[GJ[okazk4Rw3iR\_[Jn2Y{beL_ek^ax66Pwwz^Hm/(1WLdrJ|zGLDDh @`l"L@SbOD4 E V&74Z}? ??S d\R|I@z t_5bXXSCp@ufjZPd~8 a}a?%Tz#fr]} )arE1/KP!}2HSY-=7! 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. 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). 3 0 obj 5 0 obj Please click here to register for an account. Updates to Cigna's policies and procedures, Announcements of new Cigna electronic tools and services, Clinical, pharmacy, and Medicare Advantage updates. Committed to cultural competency. All insurance policies and group benefit plans contain exclusions and limitations. 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. For Cigna Medicare membership guidelines click here. Ethics & Compliance | 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. All material on this website is, unless otherwise stated, the property of eviCore healthcare. 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 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. Enrollment in Oscar depends on contract renewal. %-NM .t|p[!U"thV6I>sHH{[;:B#N v',(M=a!bHJ. hbbd``b` SK(La "$[" rD @Ua$"C 6#I#s Z If you're unable to file a claim right away, please make sure the claim is submitted accordingly. As of February 1, 2021, eviCore healthcare (eviCore) manages home health care, durable medical equipment (DME), and home infusion therapy for Cigna commercial customers. This website is not intended for residents of New Mexico. E-Verify and IER Right to Work. These guidelines apply to Cigna Medicare Advantage customers. a listing of the legal entities <> 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 You may save, download and print these guides for use in your office. 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. eviCore positions. Selecting these links will take you away from Cigna.com to another website, which may be a non-Cigna website. Selecting these links will take you away from Cigna Medicare Advantage and Medicare Part D Prescription Drug Plan information. endstream endobj startxref Medicare patients' claims must be filed no later than the end of the calendar year following the year in which the services were provided. Enrollment in Cigna depends on contract renewal. Message Here. Other names or logos may be trademarks of their respective owners. a listing of the legal entities 128 0 obj <>stream CocoDoc has made it easier for people to Modify their important documents by online browser. This website is not intended for residents of New Mexico. Thank you for using eviCores website today! Selecting these links will take you away from Cigna.com to another website, which may be a non-Cigna website. endstream endobj startxref See the criteria (PDF) Office manual for health care professionals To know the process of editing PDF document or application across the online platform, you need to follow these . This web site uses files in Adobe Acrobat Portable Document Format (PDF). Cigna may not control the content or links of non-Cigna websites. For availability, costs and complete details of coverage, contact a licensed agent or Cigna sales representative. If Medicare is the primary payer, timely filing is determined from the processing date indicated on the primary carrier's explanation of benefit (EOB). 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. Thank you for the quality care you provide to our members. There are some exceptions to these deadlines. 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.

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