Tag: Cigna Healthcare
Health Plan Representatives Updated 8/4/2025
The Health Plan Representatives List has been updated. This is a good tool to print and have close by when you have an issue.
The biggest change for claims issues will be HealthSpring (HCSC) formerly Cigna MA. Here is how:
- Email ALL claims issues to [email protected]
2. HealthSpring has supplied the spreadsheet that MUST be used. A link is provided below, or you may call POET, we will be glad to email you an electronic copy.
Only the columns with Red Lettering, need to be filled out by the Physician’s office.
4. Always feel free to copy [email protected] if you would like POET to be in the loop.
5. If you have a time sensitive, special, or just an issue you would like to discuss with POET, please call (936) 637-7638.
Cigna Comm. New Reimbursement Policy for E/M
Cigna Healthcare® will implement a new reimbursement policy, Evaluation and Management Coding Accuracy (R49), to review professional claims billed with Current Procedural Terminology (CPT®) evaluation and management (E/M) codes 99204-99205, 99214-99215, and 99244-99245 for billing and coding accuracy in alignment with American Medical Association (AMA) E/M services guidelines.
Effective for dates of service on or after October 1, 2025, services may be adjusted by one level to reflect the appropriate reimbursement when the AMA guidelines are not met.
What this means to you
Cigna Healthcare will conduct periodic claim reviews to verify compliance. Based on that review, providers may be eligible to be removed from the program. Supporting documentation will be requested should we determine the established guidelines were not followed.
Reconsideration requests
Providers who believe their medical record documentation supports reimbursement for the originally submitted level for the E/M service should follow the reconsideration and appeals processes.
To request a reconsideration, please submit the customer’s full record of the encounter to the secure Cigna Healthcarefax number 833.392.2092. Should the original determination be overturned, claims will be adjusted, and an updated explanation of payment will be issued.
Administrative appeal rights are available if the original determination is upheld.
Cigna Comm. Removes 96 Codes from Prior Auth. List.
To help reduce the paperwork and time providers (and patients) spend seeking approvals for more routine services, Cigna Healthcare will remove 96 codes from the list of services that require prior authorization for dates of service on and after May 31, 2025. These codes include commonly requested cardiology, otolaryngology (ENT), and other routine services.
Cigna Commercial REMOVING Multiple Services from Their Pre-Cert List.
Many services will no longer require prior authorization (i.e. Precertification) for Cigna Commercial, beginning May 31, 2025.
Please note, however, that removal from precertification is not a guarantee of payment. Codes may be subject to standard code editing, benefit plan exclusions, and post-service review for coverage.
ALERT: BCBS Not All PPO in the Suitcase Cards Follow the Rule
SAY IT ISN’T SO!
Things to look for: But remember cards are so tricky these days, what applies to one, may not apply for another:
Is the “Texas Department of Insurance” acronym TDI on the card? If a health insurance card does not have “TDI” on it, it is likely an ERISA plan, meaning it is a self-funded plan regulated by federal law and not by the Texas Department of Insurance (TDI) because the employer directly pays claims instead of relying on an insurance company; the absence of “TDI” indicates the plan is self-funded and therefore likely falls under ERISA regulations. (resource tdi.texas.gov)
Look for these phrases, usually on the back of the card:
“BCBS provides administrative services only and assumes no financial risk for claims.”
“JBS will utilize Anthem to handle member contract for Health plan administration”
“Anthem Blue Cross and Blue Shield provide administrative claims payment services only and does not assume any financial risk or obligation with respect to claims”
“BCBST provides administrative services only and assumes no financial risk for claims.”
2/11/25 Amended to add Cigna. Look for these terms on Cigna Commercial cards:
- Shared Administration (S)
- Benefits are not insured by Cigna or Affiliates
Scrutinize each member’s card on an individual patient basis. No rule is across the board.
Digital Precertification on CignaforHCP.com
- Beginning July 18, 2024, registered users with the Precertification – View and Submit entitlement have access to digital precertification correspondence via the Messaging Center on CignaforHCP.com.
- Digital correspondence notifies users when precertification letters are available, or when action is required to continue processing.
- Designate the following communication preferences by logging into CignaforHCP.com > Settings and Preferences > Communication Settings:
- The type of correspondence you want to receive (e.g., emails and/or alerts) when digital correspondence is available.
- Email notifications and frequency to alert you when new digital correspondence is available.
Digital Claim Correspondence for Cigna
Beginning today, registered users with the Claim Search entitlement have access to digital claim correspondence via the Messaging Center on CignaforHCP.com.
Cigna Provider Newsroom
WEBINAR SCHEDULE FOR DIGITAL SOLUTIONS: You’re invited to join interactive, web-based demonstrations of the Cigna for Health Care Professionals website (CignaforHCP.com). Learn how to navigate the site and perform time-saving […] Read more >
CLINICAL, REIMBURSEMENT, AND ADMINISTRATIVE POLICY UPDATES: To support access to quality, cost-effective care for your patients with a medical plan administered by Cigna Healthcare, we routinely review clinical, reimbursement, and administrative […] Read more >
COORDINATION OF CARE: Coordination of care is the process by which a patient’s team of providers cooperatively help coordinate care management and ensure access to quality, cost-effective care. […] Read more >
Cigna and Zelis
If you have accidently signed up to receive virtual credit card (VCC) payments, and would like to change back to Automated Clearinghouse (ACH), please call Zelis.
Zelis Customer Service:(877) 828-8770
If you have questions regarding claim payments, please contact Cigna Healthcare Provider Service Line (800) 882-4462.
Change HealthCare!
Looking for answers? So is POET. We are looking for work-arounds. Hopefully we will have some up before closing today.
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