Cigna Healthcare – Page 2

Cigna Digital Solutions Update 11/1/2023

Beginning October 31, 2023, when you verify eligibility for patients with a third-party administrator (TPA) plan, the electronic data interchange (EDI) 271 transaction will indicate whether they are covered or not covered using information from Cigna Healthcare, as well as the TPA. It will also provide the TPA name and telephone number to confirm further eligibility or benefit information.

What this means for you
This enhancement will provide more clarity in the coding used by clearinghouses and electronic medical records vendors to electronically confirm eligibility for your patients and provide information on the entity to contact for benefit details. You may still need to call the TPA for further information.

What are TPA plans?
Employer groups who require a high level of customization and flexibility may choose to have TPAs administer their benefit plans. Cigna Payer Solutions has relationships with select TPAs to help meet the needs of employer groups by providing a wide range of complementary product solutions, including access to our medical network of providers.

How do I determine if my patient has a TPA plan?
You have two options to determine if your patient has a TPA plan: View their ID card or log in to the Cigna for Health Care Professionals website (CignaforHCP.com) to review their coverage details.

Patients with a TPA plan will have “Shared Administration” (or the letter “S”) at the bottom right of their TPA ID card (see the sample below). This designates that Cigna Healthcare shares the administration of the plan with a TPA. The ID card also includes the TPA phone number to call for eligibility and benefits information.

Cigna Network News 3rd Quarter 2023

Claim status notifications available on the CignaforHCP.com Message Center

Cigna CoVid Coverage Changes

Changes in coverage effective May 12, 2023

The White House has announced their intent to end both the CoVid-19 National Emergency and Public Health Emergency (PHE) on May 11, 2023.

As a result, Cigna Commercial and Cigna Medicare Advantage plan to make the following changes on May 12, 2023:

Authorizations for facility-to-facility transfers will again be required.
Patient cost-share will apply to COVID-19 lab tests as well as antiviral and therapeutics approved by the U.S Food & Drug Administration (FDA).
For most benefit plans, COVID-19 vaccines will be covered at 100 percent under the preventive benefit (same as the flu shot) when customers go to an in-network provider.
Over-the-counter COVID-19 tests will no longer be covered.

Cigna 1st Qtr 2023 Network News

Cigna Delays Record Request Policy

You may have read the article posted May 23rd. Cigna (Commercial) had implemented a new policy that required medical records be sent when a minor procedure is billed with an office visit.

However, Cigna has delayed the Records Request Policy, Staving Off the “Administrative Nightmare” for now.

Cigna has delayed the implementation of a new billing policy after the Texas Medical Association and others in organized medicine pushed back, warning that it would have negative implications for physicians, practice staff, and patients.

Is Cigna Stealing?

Several Members from the MGMA Community have reported that Cigna has made ACH withdrawals from their bank account without permission.

One POET physician has reported the same.

MGMA Members suggest you contact your bank if you see a non-approved withdrawal from your account.

Update from MGMA, 6/15/2022: Please be aware Cigna experienced an isolated issue resulting in some EFT payments from settlement date May 23 being paid over the amount of the remittance advice. To minimize disruption to providers, Cigna worked with the bank to retract these EFT payments on June 1, 2022. The EFT payments for the correct amounts will be reissued around June 8, 2022 and should be available within 1 business day from reissue. Please also note that during this time, some remittance advices were delayed but have since been released.

Invitation to Test New 360 Feature

CIGNAFORHCP.COM MODERATION

You are invited to test the new Claims 360 Feature.

The new Claims 360 feature allows you to:

· Search for claims using your Tax Identification Number (TIN)

· Search by claim number

· Filter and focus on the claims you want to see

Cigna New Medical Records Nightmare

Starting Aug. 13, Cigna commercial payer will request patients’ medical records when billed for an office or other outpatient visit where a minor procedure also occurred, according to a letter sent to physicians and other health care professionals.

The Texas Medical Association and American Medical Association are monitoring the issue.

Carra Benson, TMA’s manager of practice management and reimbursement, says this new policy – and similar ones from other commercial payers – could prove to be “an administrative nightmare” given the ubiquity of office visits that include a minor procedure.

For instance, a dermatologist may discover a concerning mole and remove it during the same routine office visit. Likewise, a family medicine physician may see a patient for a scheduled joint injection and learn the patient has been experiencing chest pain and shortness of breath. If the physician sends the patient for a chest X-ray and electrocardiogram, then the physician would bill for the office visit related to the acute symptoms as well as the originally scheduled minor procedure, according to the American Academy of Professional Coders.

In coding terms, this policy change applies to evaluation and management codes 99212 through 99215, when billed with a modifier 25. That modifier is used to indicate a minor procedure, of which there are more than 1,600.

Ms. Benson says practices that often bill for such visits could find themselves overwhelmed by medical records requests from Cigna. This burden would fall especially hard on solo and small practices, which have limited staff to meet such demand, she adds.

Practices may opt to schedule follow-up visits for the minor procedure or to sever their relationship with Cigna to get around this administrative burden, Ms. Benson says. Both options constrain patients’ access to timely, continuous care.

She adds that if physicians choose to respond to Cigna’s records requests, they may be financially penalized – in the form of a refund request – for inadequately documenting the reason for the minor procedure.

Cigna did not provide a reason for the policy change in its notification letter to physicians and other health care professionals.

Blue Cross and Blue Shield of Texas also may request medical records and itemized bills from physicians and other health care professionals “to validate the site of service, level of care rendered, and services billed were accurately reported,” according to its clinical payment and coding policy.

UnitedHealthcare policy doesn’t mention medical record requests in the context of office visits with a minor procedure, but Ms. Benson says practices may still see the issue arise.

Practices that have received notice from Cigna or are dealing with negative ramifications related to similar policies can request a coding and documentation review from TMA Practice Consulting. The service includes an in-depth review of medical record documentation and claims coding that identifies deficiencies and areas of risk.

Cigna Continues CoVid Accommodations

Over-the-counter testing

Consistent with new federal guidelines for private insurers, Cigna commercial will cover up to eight over-the-counter (OTC) diagnostic COVID-19 tests per month (per enrolled individual) with no out-of-pocket costs for the tests. This coverage began January 15, 2022 and continues through the end of the PHE (currently through April 15, 2022).

Please note that while Cigna Medicare Advantage plans do fully cover the costs for COVID-19 tests performed in a clinical setting, costs of at-home COVID-19 tests are not a covered benefit at this time.

Additionally, we encourage you to remind your patients that the Federal Government is now offering four free at-home test kits per household with no cost. Your patients can order the free at-home COVID-19 testing kits at COVIDtests.gov.

Coverage of COVID-19 treatments

As a reminder, Cigna commercial and Cigna Medicare Advantage cover FDA emergency use authorized (EUA) treatments of COVID-19, including monoclonal antibody treatments. This includes new antiviral medications Paxlovid^TM and molnupiravir, as well as Remdesivir infusions when administered in an inpatient or outpatient setting.

Get all the most up-to-date information

We updated our dedicated COVID-19 provider web page on January 21, 2022 to highlight these updates more. You can also access the latest Cigna Medicare Advantage billing guidelines from this page. Please visit the site often to get the latest information.

POET Is Seeing a Trend, UPDATE

On January 5th, Sir Seymore posted on Ink that POET is seeing a trend from Physician Offices that are trying to get a referral from Cigna MA.

Please scroll down to review that post for details.

POET received this information from Cigna MA: “Unfortunately, we’re experiencing a known enterprise-wide issue within the MHK/HSConnect platform that is affecting how many of our participating specialists are reflecting in the dropdown box or search box when attempting to generate a referral. The MHK/HSConnect team is working towards remediation but I have not yet heard when the expected date for completion might be.”

Just a reminder: SCPs do not need a referral due to the Public Health Emergency (PHE). The PHE has been extended until April 16, 2022.

PCPs and SCPs you are welcome to confirm participation with POET or Leslie.

Per Cigna MA, you should be able to manually enter the specialists’ (SCP) name/NPI for a referral.

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