CIGNA-HEALTHSPRING CLAIMS SUBMISSION INSTRUCTIONS ... • Understand the proper claim submission process

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  • CIGNA-HEALTHSPRING CLAIMS SUBMISSION INSTRUCTIONS

    Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna

    Presenter Presentation Notes Misdirected Claims Training

  • HOW TO AVOID MISDIRECTED CLAIMS

    2 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna

  • • Understand the proper claim submission process

    • Recognize the impact misdirected claims cause to customers, providers,

    and Cigna-HealthSpring

    • Assist in a service improvement to providers and customers

    Objective:

    3 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna

    Presenter Presentation Notes Tip: There will be a Knowledge Check requirement at the conclusion of this training

  •  C-HS – Cigna-HealthSpring

     EDI -Electronic Data Interchange

     IVR - Interactive Voice Response

     PCP – Primary Care Provider

     FDR – First Tier Downstream and Related Entity

    Acronyms

    4 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna

  • MISDIRECTED CLAIMS

    5 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna

  • We recently enhanced our process for redirecting claims sent to the C-HS offices in error. While we are redirecting these claims timely, to assist our providers we created a checklist to help in identifying proper submission of claims to the entity responsible for claims processing and payment.

    Overview:

    6 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna

  •  Check Customer’s ID Card

     View HSConnect Portal

     Connect to the IVR

     Contact the Provider Service line

     Identify the Customer’s Provider Network

    Checklist:

    7 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna

  • CUSTOMER ID CARD

    8 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna

  • Providers are encouraged to check Cigna-HealthSpring customer’s ID cards for guidance on proper claims submission.

    Customer ID Card - Introduction

    9 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna

  • The front of the customer’s ID card will contain the following information:

    • Plan Name

    • Health Plan

    • Customer Name

    • PCP Name

    • PCP Phone

    • Network

    Customer ID Card (Front)

    10 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna

    • RxBIN

    • RxPCN

    • Contract & PBP Number

    • Copays:

    • PCP

    • Specialist

    • ER

    • Urgent Care

  • • One of the fields on the ID card that can assist providers with proper claim submissions is “Network.”

    • A customer’s Network may sometimes help providers determine the entity to which the claims should be submitted to:

    Customer ID Card (Front)

    11 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna

  • The back of the customer’s ID card will contain the following information:

    • Customer Service phone number

    • Provider Services phone number

    • Authorization/Referral phone number

    • Medical Claims Submission Address

    • Pharmacy Help desk phone number

    • Pharmacy Claims Address

    • 24 Hour Health Information Line phone number

    • Website

    Customer ID Card (Back)

    12 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna

  • • When submitting claims please be sure to check the back of the customer’s ID card • The field “Medical Claims” will provide you with the correct claims address to mail in

    the claim.

    Customer ID Card (Back)

    13 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna

  • CLAIM SUBMISSION

    14 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna

  • The following sections will show the proper claims submission information where paper and Electronic Data Interchange (EDI) claims can be submitted. This is determined by identifying the network the provider is participating in for Cigna-HealthSpring customers.

    Mailed/Electronic Claims Submission

    15 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna

  • NETWORKS

    16 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna

  • The following information will assist you in identifying the appropriate address for mailed claims submission depending on the provider network. When submitting claims for IPAs (or other non-Cigna-HealthSpring independent entities), always include the IPA or entity name in the mailing address to avoid issues with claims processing. Tip: The network is stated on the front of the customer ID Card.

    Network Identification

    17 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna

  • 18 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna

    C-HS Market IPA / Independent Entity (if applicable) Claims Mailing

    Address

    Alabama

    N/A

    Cigna-HealthSpring P.O Box 981706

    El Paso, TX 79998

    Alabama

    Baldwin Physician Network Cullman Primary Care IPA

    Dallas Etowah

    East Jefferson (JEST) Franklin Medical Network

    Little River Canyon Princeton Premier IPA

    Providence Medical Network Red Mountain River Region

    Shelby Chilton Southern Medical Physicians

    Summit West Synergy Tallaco

    Tennessee Valley Walker

    West Alabama

    Please Insert IPA Name P.O Box 981706

    El Paso, TX 79998

  • 19

    C-HS MARKETS IPA / Independent Entity (if applicable)

    Claims Mailing Address

    Alabama (Southern Mississippi) (SMS)

    Hattiesburg IPA Lighthouse IPA

    Please Insert IPA Name P.O Box 981706

    El Paso, TX 79998

    Alabama (Georgia) (Atlanta)

    CAAP Health Network IPA CAAP Health Network IPA P.O Box 981706

    El Paso, TX 79998

    Georgia N/A Cigna-HealthSpring P.O Box 981706

    El Paso, TX 79998

    Illinois (Medicare Advantage) Advocate Health Centers Advocate P.O. Box 0522

    Mount Prospect, IL 60056

    Illinois Health Select Medical Care Group

    Please Insert IPA Name P.O Box 981706

    El Paso, TX 79998

    Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna

  • C-HS MARKETS

    IPA / Independent Entity (if applicable)

    Claims Mailing Address

    Illinois Swedish Covenant Managed Care

    SCMCA 2740 W. Foster Ave.,

    Ste 409 Chicago, IL 60625

    Illinois

    University of Chicago University of Chicago c/o MPAS

    P.O. Box 3358 Glen Ellyn, IL 60138

    Missouri (Kansas City) N/A Cigna-HealthSpring P.O Box 981706

    El Paso, TX 79998

    Mid-Atlantic

    DC Qual-Care IPA Trendsetter IPA

    Please Insert IPA Name P.O Box 981706

    El Paso, TX 79998

    Mid-Atlantic

    N/A Cigna-HealthSpring P.O Box 981706

    El Paso, TX 79998

    20 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna

  • C-HS MARKETS

    IPA / Independent Entity (if applicable)

    Claims Mailing Address

    Mid-Atlantic (Pennsylvania)

    Ben Franklin Physicians IPA Broad Spectrum IPA Delco Wellness IPA

    Liberty Independent Physicians Group

    Prestige Physician Group

    Please I

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