Cigna
DMGMA Annual Update
Lorie Jennings-Forrester
March 21, 2012
Cigna – Annual Update
Today’s Topics:
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•
•
•
•
•
•
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Cigna’s New Branding
Integration News
HCP Website review
Cost of Care Estimator update
EDI Attachments & Corrected or Secondary Claims
Online Remittance Reports
MedSolutions, Inc
Bravo Health
HIPAA-5010/ICD10
Demographic Changes
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2011 Cigna
2
Cigna’s New Brand:
Some of the changes you may have seen or will notice in
the coming months:
• Our name
• Our logo
• ID cards
Our new brand identity more closely aligns with our
strategy and our mission, to help the people we serve
improve their health, well-being and sense of security.
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2011 Cigna
3
Cigna’s New Brand:
Our Name:
We are still Cigna, but now you’ll see that we are using
both upper and lower case letters.
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2011 Cigna
4
Cigna’s New Brand:
Our Logo:
We’ve changed our logo to reflect our focus on our
customers (your patients) and our commitment to
connect people with quality health care.
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2011 Cigna
5
Cigna’s New Brand:
Our ID Cards:
•The Cigna Logo has
been removed
•The card background
is now white
•The Cigna name now
appears in upper &
lower case letters
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2011 Cigna
6
Integration News
The Cigna and GWH-Cigna contracts integrated
04/01/2011
• Cigna Agreement and its rate schedules will apply to
GWH-Cigna patients.
• Integrated Payor ID
• Separate claim and call services for your patients
• Separate Networks
• Different contractual relationships with Vendors
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2011 Cigna
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Integration News
Introducing one payor ID for claim submission
As part of Cigna’s enhancements to support the Version 5010 updates,
we have consolidated to one Cigna payor ID (62308)
*If your clearinghouse has not migrated to 5010, you will still require
separate payor ID’s for GWH and Cigna.
Old GWH-Cigna payor ID that is being integrated: ID 80705
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2011 Cigna
8
Integration News
Separate Call & Services Channels continue
• Cigna maintains separate networks for your patients with
GWH-Cigna ID cards
• Continue to reference the ID card
• ID card still has GWH-Cigna listed in top right corner
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2011 Cigna
9
Integration News
Once secure website coming soon
• We will transition to one secure website for both the Cigna
and GWH-Cigna networks within the fourth quarter of 2012
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2011 Cigna
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Cigna eServices
Cigna Has Two Websites Which Are Free to Use
If you provide service to customers with Cigna ID cards, access
this website for:
Cigna for Health Care
Professionals Website
www.cignaforhcp.com
• Eligibility and benefit inquiries
• Patient liability estimator
• Precertification
• Claim status inquiry
• Remittance reports
• View Claim Coding Edits
• Other resources
If you provide service to customers with GWH-Cigna ID cards,
access this website for:
Secured Provider Portal
www.gwhcignaforhcp.com
•
•
•
•
•
•
Eligibility and benefit inquiries
Precertification
Claim status
Claim payment and explanation
View Claim Coding Edits
Other resources
Confidential,
unpublishedConfidential,
property of Cigna.
Do notproperty
duplicate
distribute.
and distribution
limited
to authorized
personnel.
2011 Cignapersonnel. © 2011 Cigna
THN-2011-051
unpublished
of or
Cigna.
Do notUse
duplicate
or distribute.
Usesolely
and distribution
limited
solely to© authorized
11
Cigna eServices
Enter your User ID and Password to log in to the Cigna for Health Care Professionals
website (www.cignaforhcp.com)
Confidential, unpublished
property
of Cigna. property
Do not duplicate
Use and
distribution
limited
solely to authorized
personnel.
© 2011personnel.
Cigna © 2011 Cigna
THN-2011-051
Confidential,
unpublished
of Cigna.orDodistribute.
not duplicate
or distribute.
Use
and distribution
limited solely
to authorized
12
Resources Page
• Cigna reference
guides
• Claim appeals policy
• Claim submission
addresses and
requirements
• Disease
management
programs
• Electronic
prescription
submission
• Pharmacy formulary
• Provider directory
Remember to check
the site often for
policy and procedure
updates.
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2011 Cigna
13
Cigna eServices
• Enter your User ID and
Password to log in to the
Secured Provider Portal
(www.gwhcignaforhcp.com)
• If you are not already registered
to use the website, click
“Register Now”.
Confidential, unpublished
property
of Cigna. property
Do not duplicate
Use and
distribution
limited
solely to authorized
personnel.
© 2011personnel.
Cigna © 2011 Cigna
THN-2011-051
Confidential,
unpublished
of Cigna.orDodistribute.
not duplicate
or distribute.
Use
and distribution
limited solely
to authorized
14
Secured Provider Portal – Home Page
• View important
updates to plans and
services
• Check the details of
processed claims
• View precertification
requirements
• Access helpful
resources, including:
Clinical guidelines
Payment guidelines
Dispute resolution
Reference guides
Note: Some links may
redirect to
cigna.com or
cignaforhcp.com
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2011 Cigna
15
Cost of Care Estimator
Cost estimation capability now available for patients
Using a secure website, your patients with Cigna
administered medical coverage can:
• Compare quality & outcomes measures for services
• Produce personalized cost estimates
• Research cost
This new capability is an extension of our efforts to offer
transparency to our customers, and help them better
understand what they can expect to pay out of pocket.
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2011 Cigna
16
Cost of Care Estimator - updates
Estimating tool for Health
Care Professionals:
• Now Available for more plans:
HMO/Network, Open Access,
PPO, POS
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2011 Cigna
17
Electronic Claims Submissions
Attachments and Corrected/Secondary Claims
• Cigna accepts secondary claims electronically
• Cigna accepts corrected claims electronically
Milliman Study: electronic transaction savings
opportunities
Savings/
Transactions
Estimated
Manual Cost Electronic Cost Transaction
Per Year
Annual Savings
Claims
$6.63
$2.90
$3.73
6,200
$23,124.21
Eligibility Verification
$3.70
$0.74
$2.95
1,250
$3,693.04
Referrals
$8.30
$2.07
$6.22
1,000
$6,223.17
Preauthorization
$10.78
$2.07
$8.71
100
$870.62
Payment Posting
$2.96
$1.48
$1.49
4,340
$6,456.59
Claim Status
$3.70
$0.37
$3.33
620
$2,065.59
TOTAL:
$42,433.23
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2011 Cigna
18
Online Remittance Reports
www.cignaforhcp.com
• View your Remittance Reports online same day
• Reconcile payments same day
• New remittance tracking number
• Search and download online reports
• Reduce the amount of paperwork you receive
• As of September 2, 2011, Remittance Reports are
only available online
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2011 Cigna
19
Cigna and MedSolutions, Inc
Effective October 1, 2011 CIGNA, including the GWHCIGNA network has entered into an expanded
relationship with MedSolutions, Inc.(MSI) to provide
radiology benefit and network management services.
• The following services do not require
utilization management review and will not be
affected by this change:
Inpatient high-technology radiology services
Emergency Room radiology services
Outpatient radiology services other than CT,
MR, PET, and nuclear cardiac studies
• MSI will finalize claim payments for the
outpatient, non-emergent high-technology
radiology procedures
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2011 Cigna
20
ABOUT HEALTHSPRING
Cigna acquired HealthSpring, Inc. and its subsidiaries, including Bravo Health, a
HealthSpring company, and HealthSpring of Florida, on January 31, 2012.
• One of the nation’s largest health plans, whose primary focus is Medicareeligible individuals
• HealthSpring is based in Nashville, Tennessee, and currently operates Medicare
Advantage plans in the following states:
Alabama
Georgia
Mississippi
Tennessee
West Virginia
Delaware
Illinois
New Jersey
Texas
Florida
Maryland
Pennsylvania
Washington, D.C.
• Includes a national stand-alone prescription drug plan
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2011 Cigna
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WORKING TOGETHER
What the acquisition means to health care professionals
• There are no changes to how health care professionals interact with Cigna or
HealthSpring.
• Continue to use existing processes and procedures for Cigna and HealthSpring.
• There are no changes to:
– Network participation – health care professionals who participated in just one network
prior to the acquisition, continue to participate in only that network today
– Contracts
– Fee schedules
– Administrative processes – Continue to use the same claim, eligibility and benefits
checks, and precertification procedures that you use today
– Referral procedures – Continue to refer patients to network participating physicians,
facilities, and vendors
– Patient ID cards
– Contacts
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2011 Cigna
22
HIPAA 5010
• Frequently Asked Questions (FAQs) are available on our website
(www.cignaforhcp.com > Resources > Communications > HIPAA 5010/ICD10 Updates)
or call 1.800.88CIGNA (882.4462) if you have questions about the changes
required or CIGNA's readiness to support the required changes.
***Companion guides are available through your clearinghouse vendor.
ICD-10
The federal government, through the Centers for Medicare and Medicaid Services
(CMS), is driving the health care industry to upgrade diagnosis and procedure
coding standards to ICD-10 by October 1, 2013.
On February 16, 2012, the Department of Health and Human Services announced
the intent to delay the ICD-10 mandatory implementation date of October, 1st,
2013. Cigna will continue work on Enterprise compliance based on current project
plan deliverable timelines.
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2011 Cigna
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COMPLIANCE TIME LINE
Cigna is working towards the ICD-10 compliance date of October 1, 2013.
2011
2012
2013
Regulatory Time Line
October 1, 2012
ICD-10 External
Testing
2014
2015
2016
October 1, 2013
ICD-10
Compliance
ICD-9
processing
Dual
processing
(ICD-9 and ICD-10)
Design solutions for ICD-10
Leverage ICD-10
Process
ICD-10
claims and
support ICD-9
runoff
ICD-10
processing
value
realized
ICD-10-Based Claims
ICD-9-Based Claims
Health plans will need to accept both ICD-9 and ICD-10 codes
for several years to support claim runoff after the
ICD-10 compliance date of October 1, 2013.
1.
2.
Accept ICD-9 claims for dates of service or
discharge before the October 1, 2013
compliance date
Accept ICD-10 claims after October 1, 2013
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2011 Cigna
24
Demographic Changes
Please notify us in writing 90 days before changing your office or billing
address, telephone number, tax identification number or specialty.
Submit your demographic changes to:
State
Submission Options
Connecticut, Delaware, Illinois, Indiana, Iowa,
Maine, Massachusetts, Michigan, Minnesota,
New Hampshire, New Jersey, New York, Ohio,
Pennsylvania, Rhode Island, Vermont, West
Virginia, Wisconsin
■ Phone: 1.888.663.8081
■ Fax: 1.877.358.4301
■ Email: [email protected]
Alabama, Arkansas, Florida, Georgia, Kentucky,
Louisiana, Maryland, Mississippi, North Carolina,
Oklahoma, Puerto Rico, South Carolina,
Tennessee, Texas, Virginia, Virgin Islands,
Washington DC
■ Phone: 1.888.663.8081
■ Fax: 1.888.208.7159
■ Email: [email protected]
Alaska, Arizona, California, Colorado, Hawaii,
Idaho, Kansas, Missouri, Montana, Nebraska,
Nevada, New Mexico, North Dakota, Oregon,
South Dakota, Utah, Washington, Wyoming
■ Phone: 1.888.663.8081
■ Fax: 1.860.687.7336
■ Email: [email protected]
Confidential, unpublished
property
of Cigna. property
Do not duplicate
Use and
distribution
limited
solely to authorized
personnel.
© 2011personnel.
Cigna © 2011 Cigna
THN-2011-051
Confidential,
unpublished
of Cigna.orDodistribute.
not duplicate
or distribute.
Use
and distribution
limited solely
to authorized
25
Questions?
"Cigna" is a registered service mark and the "Tree of Life" logo is a service mark of Cigna Intellectual Property, Inc., licensed for use by
Cigna Corporation and its operating subsidiaries. All products and services are provided by such operating subsidiaries and not by Cigna
Corporation. Such operating subsidiaries include Connecticut General Life Insurance Company, Cigna Health and Life Insurance Company,
and HMO or service company subsidiaries of Cigna Health Corporation and Cigna Dental Health, Inc.
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© 2012 Cigna