Download pdf - CIGNA-HEALTHSPRING CLAIMS SUBMISSION INSTRUCTIONS...• Understand the proper claim submission process • Recognize the impact misdirected claims cause to customers, providers, and

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Confidential, unpublished property of Cigna.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2 Confidential, unpublished property of Cigna.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:


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


MISDIRECTED CLAIMS


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:


Check Customer’s ID Card

View HSConnect Portal

Connect to the IVR

Contact the Provider Service line

Identify the Customer’s Provider Network

Checklist:


CUSTOMER ID CARD


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

Customer ID Card - Introduction


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)


• 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)


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)


• 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)


CLAIM SUBMISSION


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


NETWORKS


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



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

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


Alabama (Southern Mississippi) (SMS)

Hattiesburg IPA Lighthouse IPA


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


El Paso, TX 79998


C-HS MARKETS

IPA / Independent Entity (if applicable)


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


El Paso, TX 79998

Mid-Atlantic

N/A Cigna-HealthSpring P.O Box 981706

El Paso, TX 79998


C-HS MARKETS



Mid-Atlantic (Pennsylvania)

Ben Franklin Physicians IPA Broad Spectrum IPA Delco Wellness IPA

Liberty Independent Physicians Group

Prestige Physician Group


El Paso, TX 79998

Mid-Atlantic (Pennsylvania)

N/A Cigna-HealthSpring P.O Box 981706

El Paso, TX 79998

North Carolina N/A Cigna-HealthSpring P.O Box 981706

El Paso, TX 79998

South Carolina N/A Cigna-HealthSpring P.O Box 981706

El Paso, TX 79998

Tennessee Synergy HealthCare, LLC Clarksville Medical Network

East Memphis Medical Network HCA - TriStar Medical Network

KMG Memphis Midtown IPA


El Paso, TX 79998



C-HS Markets



Tennessee

North Tennessee Medical Network

Premier IPA Rutherford County

Scenic City IPA


El Paso, TX 79998

Tennessee N/A


El Paso, TX 79998


C-HS Markets



Tennessee

North Tennessee Medical Network

Premier IPA Rutherford County

Scenic City IPA


El Paso, TX 79998

Tennessee N/A


El Paso, TX 79998

C-HS Markets



Texas N/A Cigna-HealthSpring

P.O Box 981706 El Paso, TX 79998

Texas El Paso Integral Care (EPIC) El Paso Integral Care


Texas Prospect Medical Group Prospect Medical Claims

P.O. Box 11466 Santa Ana, CA 92711-14466

Texas WellMed WellMed Claims P.O. Box 400066

San Antonio, TX 78229

C-HS MARKETS



Texas Renaissance Physician

Organization

Renaissance Physician Organization Attn: Claims

P.O. Box 2888 Houston, TX 77252-2888

Texas Valley Organized Physicians Valley Organized Physicians Claims



ELECTRONIC DATA INTERCHANGE (EDI) CLAIMS


EDI is the most common and preferred method of claims submission by providers. Cigna-HealthSpring has direct connections with the following clearinghouses for submission of EDI claims.

Electronic Data Interchange (EDI)


All Cigna-HealthSpring providers can use the following clearinghouses:

Clearing Houses: All Markets


Change Healthcare Availity McKession/Relay

Presenter

Presentation Notes

Providers who wish to use Relay Health as their clearing house will have to enroll with Relay Health first. Providers do not have to be in network to submit EDI claims. One exception is Relay Health, which does require providers to be in network to use their services. If MAPA providers use Relay to submit their claims electronically, Cigna-HealthSpring actually receives them from Emdeon or Availity

Clearing House & Payer ID: Tennessee, Texas, Alabama, Illinois

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• The following clearing houses and payer ID can be used for the TN, TX, AL, IL markets.

Clearing House Payer ID

Change Healthcare

63092

SSI Group 63092

Proxymed (Caprio) 63092

OfficeAlly 63092

Availity 63092

Relay CPID2795 (Professional Claims)

CPID1556 (Institutional Claims)


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Presentation Notes

WellMED Payor ID is: WellM2

Clearing House & Payer ID: Georgia, South Carolina, North Carolina and Missouri

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• The following clearing houses and payer ID can be used for the GA, SC, NC and MO markets.


Change Healthcare

52192

SSI Group 63092

Proxymed (Caprio) 63092

OfficeAlly 63092

Availity 63092

Relay CPID2795 (Professional Claims)

CPID1556 (Institutional Claims)


Presenter

Presentation Notes

WellMED Payor ID is: WellM2

Clearing Houses: Mid-Atlantic and Pennsylvania market • The following clearing houses and payer ID can be used for the Mid – Atlantic and Pennsylvania markets.

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Change Healthcare 52192

Availity 63092

Relay CPID 3839 (Professional) CPID 1978 (Institutional)


Renaissance PHYSICIAN ORGANIZATION (RPO):


• Renaissance EDI claim can be submitted using the following clearing houses and payer ID’s:


Availity

THS01, HER01

Change Healthcare

33104 (Texas HealthSpring) (HealthSpring Life & Health Insurance Company)

Change Healthcare

76066 (Renaissance Physicians Organization)

Presenter

Presentation Notes

Renaissance claims are processed in EZCAP. EZCAP will process all professional claims (except Mental Health) for the following Region Codes: •RES •HOPE •DOC •INDT •LVPA •VIP •EPIC

HS CONNECT


HSConnect Portal allows participating providers access to the information and tools needed to make their interaction with Cigna-HealthSpring more efficient such as verification of customer’s provider network in order to determine claim submission addresses and vendors.

HSConnect


• In HSConnect providers can determine where to submit the claims based on the Customer Region.

• The “Customer Region” displays the network a customer is in, which can assist in

determining claims submission.

HSConnect


INTERACTIVE VOICE RESPONSE (IVR)


Cigna-HealthSpring encourages providers to use the IVR to check the following:

• Eligibility, Benefit

• Cost Share Information

• Provider Network

• Claim Information

• Claim status

• Authorization/ Referrals

• Behavioral Health

Interactive Voice Response (IVR)


When calling the IVR, providers can check a customer’s provider network to determine claim submission by following the steps outline below. • Select option 1

• The IVR will quote the Customer PCP

• The IVR will quote the Provider’s Network

• Each Market has it’s own network(s) and submit the claim according to the Market.

• Remember - the Customer Network can also be found on of the front of the Customer ID Card.

IVR – Claim Submission


PROVIDER SERVICE CALL CENTER


Cigna-HealthSpring’s Provider Call Center 1-800-230-6138 can perform the following functions:

• Verify Benefits

• Claims status

• Claim Submissions

• Customer Eligibility

• Check Tracers

• Low service time

The provider customer service call center is available Monday through Friday from 7:00 a.m. to 6:00 p.m. CST.

Provider Call Center


IMPACT TO CUSTOMERS, PROVIDERS, AND CIGNA-HEALTHSPRING


Inappropriate submission of claims will impact Cigna-HealthSpring customers in many ways. Below are a few examples:

• Bills

• Customer’s may receive a bill from a provider who has not received payment for a claim that was misdirected to Cigna-HealthSpring’s claim department instead of the network (FDR) responsible for claims processing and payment.

• Letters & Calls

• Cigna-HealthSpring customers may also receive letters from providers asking them to contact the health plan because they have not received payment.

Impact on Customers


Inappropriate submission of claims can also have an impact on Cigna- HealthSpring providers. Here is a key example of this:

• Delay of Payment

• When a claim is misdirected to Cigna-HealthSpring it may cause a delay in the timely processing of the claim.

• A delay in processing the claim timely can then result in the delay of payment to our providers.

Impact on Providers


Cigna-HealthSpring customers and providers are the key to our health plan’s success. Misdirected claims causes an adverse impact on both customers and providers. We strive for customer and provider centricity every day.

• Customer Disenrollment:

• As a result of receiving bills, calls and letters from providers who have not received payment for a service, customers may request to disenroll from Cigna-HealthSpring.

• Provider Relationship:

• Providers who do not receive timely payment as a result of misdirected claims may become frustrated and may elect not to renew their contract with C-HS.

Impact on Cigna-HealthSpring


All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company, Cigna Behavioral Health, Inc., HealthSpring Life & Health Insurance Company, Inc., and HMO or service company subsidiaries of Cigna Health Corporation. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. INT_16_43772 05192016 © 2016 Cigna. Some content provided under license.

Thank you for your participation in the Cigna-HealthSpring Medicare Advantage network