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Fall 2021Medicare AdvantageNETWORKINSIDERA resource for providers2022 MEDICARE ADVANTAGE PLAN HIGHLIGHTSMore patients, expanded benefits in the year aheadStarting in 2022, your patients with Cigna Medicare Advantage plan coveragewill have more comprehensive health benefits than ever before. And becausewe’re expanding in regions across the U.S., Cigna Medicare Advantagenetwork-participating providers will have the flexibility to see additionalpatients with preferred provider organization (PPO) coverage.IN THIS ISSUE2We’re also introducing innovative plan features to: Address the complexities of evolving patient care needs Offer you more support for better treatment outcomes and overall healthContinued on page 4COVID-19 tools and resourcesCOVID-19 guidance continues to evolve, based on the most currentscientific information available. On page 6, you'll find the latest updates,as well as provider resources and tools to support your practice. VisitMedicareProviders.Cigna.com for: Billing guidelines Telehealth CPT and diagnosis codes FAQs Virtual Care Reimbursement Policy information Links to CMS COVID-19 vaccine resourcesPCOMM-2021-1489360 ComprehensiveAssessment gets patients’health on track3A message from ourChief Medical Officer8Part D SUPD exclusions,new quality measures10Streamlined support foryour practice11SNP-MOC training,simplified
360 COMPREHENSIVE ASSESSMENTA valuable roadmap to help get your patients’ health back on trackLast year, COVID-19 prompted many people to put offroutine preventive care. Now, as more of your patientsreturn to in-person visits, we encourage you to use theannual 360 Comprehensive Assessment (also known asthe 360 Exam) to help get them back on course.What the Assessment offers you and yourpatients Provides a full picture of a patient’s health — bodyand mind Helps you identify risk factors, manage healthconditions and improve overall health Combines aspects of a physical exam and a healthassessment, and is a conversation enabler Serves as a wellness visit or a chronic diseasefollow-up visit Assists with comprehensive assessment andtreatment planningAdditionally, your patients may be eligible to earn a 50 gift card for completing their yearly 360Comprehensive Assessment by December 31, 2021.Patients with preferred provider organization (PPO)plans may also be eligible to earn up to an additional 130 in gift cards by completing certain screenings.For more information regarding your market'sprovider reimbursement for completing the360 Comprehensive Assessment, contact yourNetwork Operations Representative or emailDSS-Communications@Cigna.com.How to complete the AssessmentChoose from the following documentation platforms tocomplete the Assessment through the end of 2021: 360 Comprehensive Assessment form (paper)1 Customized electronic medical record (EMR) 360template Arcadia 360 internet-based clinical exam form2 Easy-to-use 360 Interactive Provider Partnership Guide31MedicareProviders.Cigna.com Forms Practice Support 360 ComprehensiveAssessment Form 2020 (Note: Providers may continue to use the 2020 form tocomplete 2021 Assessments.)2For more information about the Arcadia 360, contact your Network com Provider Education 360 Interactive ProviderPartnership GuideA MESSAGE FROM OUR CHIEF MEDICAL OFFICERMany older Americans still aren'tvaccinated, making the COVID-19Delta wave an even greater healthconcern. Though more than 186million Americans — and nearly 84percent of adults 65 and older —have been fully vaccinated againstCOVID-19, that's still less than 66percent of the vaccine-eligible U.S.Michael Reardon, M.D.population. That leaves more than100 million Americans without a full round of shots,according to AARP.1Seniors and individuals with pre-existing medicalconditions are the most vulnerable to becoming severelyill. The Centers for Disease Control and Prevention(CDC) states that COVID-19 infection, hospitalizationand death risk in seniors is significantly higher thanother age groups. Compared to 18- to 29-year-olds —the age group with the largest cumulative number ofCOVID-19 cases — the rate of death is four times higherin 30- to 39-year-olds, and 570 times higher in thosewho are 85 and older.2 And many individuals continue tomake vaccine decisions based on misinformation.While older Americans are more likely to be vaccinatedthan younger Americans, seniors without full vaccineprotection are at much higher risk of dying from COVID-19.Thank you for continuing to discuss the importance ofvaccination with your patients who are hesitant andurging them to take this step to protect their health.Research shows you are your patients’ most trustedinformation source.3 Read more about overcomingvaccine hesitancy on page 6.We’re in this educational effort with you. We’re sendingmailers designed to eliminate confusion, addressmisconceptions and overcome vaccination reluctanceto your Medicare patients in underserved communities.And we’re offering free round-trip transportation tovaccination sites.“Thank you for continuing to discussthe importance of vaccination withyour patients who are hesitant andurging them to take this step toprotect their health. Research showsyou are your patients’ most trustedinformation source.”To find the latest on vaccines and boosters, monoclonalantibody treatment and coverage, and billing guidelines,visit MedicareProviders.Cigna.com.We appreciate the opportunity to continue to partner withyou to bring better health to your patients.Michael Reardon, M.D.Chief Medical OfficerCigna Medicare n-death-by-age.html383% of patients trust their PCP for credible info — what about other healthcare institutions? Becker’s Hospital Review, July 2021.A note of gratitudeWe thank retiring Cigna Medicare Advantage Chief Medical Officer Gina Conflitti, M.D., for herleadership over this past year. Dr. Conflitti joined us at the beginning of 2020, before the startof the pandemic. During a period of uncertainty, fluidity and challenges, Dr. Conflitti’s strong,calm, trustworthy leadership has helped guide us. We’re grateful for her many contributions,notably developing a national clinical operating model that has enabled us to grow byproviding your patients with affordable and predictable care.2NETWORK INSIDER Gina M. Conflitti,M.D., MBA, FACPFALL 20213
2022 MEDICARE ADVANTAGE HIGHLIGHTSMore patients, expanded benefits in the year aheadExpanded benefits 0 copaymentCigna Insulin Savings ProgramDescription 0 copayment for PCP, specialist, physical therapy, speech therapy andbehavioral health visits by in-network providers or telehealth vendors Lower prescription costs for non-Low Income Subsidy (LIS) patients whohave a predictable and stable glycemic response Copayments capped at 35 per monthPart D Low Income Subsidy (LIS)Cost sharing eliminated for all covered plans, with a 0 copayment fordeductible — initial and gap coverageMedication affordability andadherenceCigna Visa Card* provides patients with a Part C cash rebate for prescriptionmedicine copayments.More opportunities for practice growth in 2022Cigna network-participating providers currently servemore than 560,000 patients with Cigna MedicareAdvantage coverage across 23 states, 477 counties andthe District of Columbia.In 2022, we will broaden our footprint into 108 newcounties — a 22 percent increase. This includes expandingin both existing and new service areas, as well as intothree new states: Connecticut, Oregon and Washington.This offers our contracted providers the potential toreach approximately 20 million additional patients withMedicare Advantage health maintenance organization(HMO) and PPO plans. Patients will newly enroll or reenroll in Medicare Advantage plans for their 2022 benefitsduring the Medicare Annual Enrollment Period (AEP),which began October 15 and runs through December 7.New benefits will be effective January 1, 2022.WashingtonOregonHealthy nutritionHealthy Benefits card* provides eligible patients with a monthly allowance forthe purchase of healthy foods from participating retailers.ConnecticutPennsylvaniaPapa program (joinpapa.com) pairs older adults with companions to assist with:In-home support, social isolationand depression supportIllinoisUtahDelawareMarylandColorado Everyday tasks, virtually or in their homes, and offers social activitiesKansas Transportation to and from doctors’ appointments, medication pickup, etc.New JerseyOhioMissouri Light housekeepingArizonaNewMexico* Not available in all markets. Contact your Network Operations Representative for more abamaPlan expansion2022 ID cardsidentify CignaMedicareAdvantagepatientsTexas3 new states — CT, OR, WA10811915223New MA countiesNew MMO countiesNew PPO countiesNew D-SNP countiesP D P O N LYWant to learn more?PDP & MED SUPPM E D I C A R E A DVA N TAG E , P D P & M E D S U P PContact your Network Operations Representative.N E W S TAT E S F O R M A , P D P & M E D S U P P4NETWORK INSIDER FALL 20215
CONTINUED CARE DURING COVID-19Resources for you and your patientsCOVID-19 guidance continues to evolve based onthe latest scientific information available. For thelatest in Cigna Medicare Advantage coverage, interimaccommodation information, billing guidelines, andanswers to your diagnostic and treatment questions,visit MedicareProviders.Cigna.com.Patients with post-COVID-19 conditionsIf you’re caring for patients experiencing post-COVID-19conditions (persistent physical and mental healthsymptoms following a COVID-19 infection), you can findresources that support holistic, empathetic treatmentapproaches at CDC.gov coronavirus.COVID-19 and flu vaccinationsYou’re a trusted resource for your patients as theymake decisions about whether to get COVID-19 andflu vaccines. You play a critical role in proactively andstrongly endorsing vaccinations for all of your patients,as clinically appropriate.Fall typically marks the start of the flu season.This year, as COVID-19 continues to pose a healththreat, it’s more important than ever to discuss withyour patients the benefits of getting vaccinated.For helpful tips on framing the conversation, go toMedicareProviders.Cigna.com COVID-19 & Flu Season:How to Talk to Your Medicare Patients.Navigating vaccine hesitancyWith the emergence of COVID-19 variants, patients need your guidance to make decisions about getting vaccinated.Dr. Elizabeth Stahl, Regional Medical Director for CareAllies*, offers these tips to help overcome vaccine hesitation:MDLIVE: Behavioral health support for yourpatientsMDLIVE offers a telehealth option for care thatcomplements — not replaces — the way your patientsinteract with you, as well as providing additionalsupport for you and your patients with complexcare needs. It’s a resource for network-participatingproviders who want to seamlessly make behavioralhealth referrals for their patients.Cigna has expanded its partnership with MDLIVE tooffer virtual behavioral health services to your Medicarepatients. Effective Q1 2022, MDLIVE will offer medical andbehavioral health appointments via video or phone to yourpatients with Cigna Medicare Advantage plan coverage.Monoclonal antibodiesLack of mobility/transportationBe empatheticForgetfulnessRealize some patients haven’t been told they need the vaccineNo vaccine education or guidanceLearn the reasons for hesitancyMisinformationAddress any misinformation (or information gaps)Difficulty getting an appointmentSpeak to reservations regarding side effectsMonoclonal antibody treatment remains a clinicallyeffective, critical tool to help fight COVID-19. Despite this,these treatments often go unused for myriad reasons.Because many of your patients may be unaware of thetreatments and where to receive them, we encourageproviders, including hospitals, to prescribe the medicationsand arrange the infusion sites necessary to administer thedrugs when medically necessary and prudent to do so.Financial confusionMake sure your staff is prepared to answer vaccine-relatedquestionsYou can find facilities that offer these treatments througha number of resources, including: CAHPS/HOS/HEDIS/Part D online catalog, whichprovides tips on communicating with your patients(available through your Network OperationsRepresentative)1Available at istribution#distribution-locations2Available at vid-antibodytreatment-resource-page The U.S. Department of Health and Human Servicesoutpatient antibody treatment locator tool,1 whichdisplays locations that have received shipments of FDAEUA-approved monoclonal antibody therapeutics withinthe past several weeks* CareAllies , a Cigna business, has an extensive and successful history of innovative value-based provider collaborations. Register at Events.CareAllies.com/ValuableInsights, oremail Info@CareAllies.com with questions. Once registered, you’ll be notified when new resources are added. The National Infusion Center Association COVID-19Antibody Treatment Locator,2 which helps providersfind infusion centers that are administering COVID-19antibody therapies6 NETWORK INSIDER Mental health awareness training to help you manageCOVID-related mental health needs (available atMedicareProviders.Cigna.com Provider Education)Questions? Contact Provider Customer Service or yourNetwork Operations Representative.Maneuver conversations to resolve hesitation:Watch Dr. Stahl’s webcast on navigating vaccine hesitancy at CareAllies.com Insights Valuable Insights:Navigating Through COVID-19 Vaccine Hesitancy to learn more and earn 0.5 CME credits.These tools and resources can also help improve patient/provider communication:Your Cigna Medicare Advantage patients can accessMDLIVE by calling 1-866-918-7836 (TTY 711) or byregistering online for an MDLIVE appointment viamyCigna.com.Understand patients’ hesitancy:Lack of access (for marginalizedcommunities)Additional resourcesFALL 20217
PART D: SUPD EXCLUSIONS,NEW QUALITY MEASURESGreater flexibility in treatment planning for diabetes patientsHistorically, end-stage renal disease was the only condition excluded from the Centers for Medicare & MedicaidServices’ (CMS) Statin Use in Persons with Diabetes (SUPD) quality measure. CMS has now issued additional SUPDexclusions, as shown in the chart below.New SUPD exclusionsThese exclusions represent conditions that could alter the clinical risk/benefit ratio of starting a statin in patients withdiabetes who have certain comorbidities. Additionally, they support treatment decisions without negatively impactingquality measures. Those that would most likely affect the Medicare population include rhabdomyolysis, prediabetes andliver disease. Pregnancy, lactation and Polycystic Ovarian Syndrome are other excluded conditions. Below is an expandedlist of exclusions for the SUPD sLiver diseaseEnd-stage renaldiseaseICD-10CODEDESCRIPTIONG72.0Drug-induced myopathyG72.9Myopathy, unspecifiedM60.80Other myositis, unspecified siteM62.82RhabdomyolysisT46.6X5AAdverse effect of antihyperlipidemic and antiarteriosclerotic drugs, initial encounterR73.03PrediabetesR73.09Other abnormal blood glucoseB18.2Chronic viral hepatitis CK70.0Alcoholic fatty liverK72.00Acute and subacute hepatic failure without comaK74.0Monitoring risks with medication useCMS is considering adopting new Part D quality measuresto monitor risks associated with certain medication use,including: Antipsychotic use in Persons with Dementia (APD) Polypharmacy – Anticholinergics (Poly-ACH) Two related to opioid use: Use of Opioids at High Dosage in Persons withoutCancer (OHD) Use of Opioids from Multiple Providers in Personswithout Cancer (OMP)New opioid safety measure on concurrent benzodiazepine useHepatic fibrosis 30 days of concurrent use of opioids andbenzodiazepinesto the adverse effects of benzodiazepines, dueto age-related changes in pharmacokinetics andpharmacodynamics.2 Centers for Disease Controland Prevention guidelines recommend that cliniciansavoid prescribing concurrent therapy wheneverpossible.3N18.5Chronic kidney disease, stage 5What to knowWhat to doN18.6End-stage renal diseaseN19Renal failure, unspecifiedZ99.2Dependence on renal dialysisConcurrent use of benzodiazepines and opioids cancause central nervous system depression, decreaserespiratory drive and increase the risk for potentiallyfatal overdose.1 Older adults are especially vulnerableStay up to date on CMS’s opioid measures,recommendations for deprescribing, supportivetherapies to offer your patients and more by visitingMedicareProviders.Cigna.com Pharmacy Resources.CMS is considering new prevention measures to reducethe overuse and misuse of prescription opioids amongMedicare Part D patients who have: 2 unique claims for a benzodiazepine* ICD-10 code list is illustrative and not comprehensive. Contact your Network Operations Representative with questions.For more information about SUPD exclusions, see our Medicare Advantage Part D Partnership Guide or SUPD educationalflyer at MedicareProviders.Cigna.com Pharmacy Resources.8Cigna has created provider guides for each of thesemeasures to help you proactively identify patientswho may need changes to their medication regimensto avoid additional risk. These guides are availablefor download at MedicareProviders.Cigna.com Provider Education. To order a supply, contact yourNetwork Operations Representative or send an email toCAHPSandHOS@Cigna.com (be sure to mention thestate you practice in).NETWORK INSIDER 1FDA Drug Safety Communication: FDA requiring Boxed Warning updated to improve safe use of benzodiazepine drug class, 2020. Accessed at ic OJ, Greenfield SF. Use of Benzodiazepines Among Elderly Patients. Psychiatric Services: Practical Geriatrics. 2004 Mar; 55(3):233-235.3Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016. MMWR Recomm Rep 2016;65 (No. RR-1):1–49.FALL 20219
STREAMLINED SUPPORTfor Your PracticeAs a Cigna Medicare Advantage contracted provider, you have immediate access to timelyupdates and 24/7 resources at your fingertips to help you do business with Cigna atMedicareProviders.Cigna.com.HSConnectProvider Portal Provider Portal User’sGuide MHK integration updatesThese resources can offerimportant information on policiesand procedures that will savetime for you and your staff.Here, you’ll find thelatest on:Provider Manual Billing (ERA/EFT support) Pharmacy quality programs;prescription drug monitoringprograms Phone numbers for keyservices and supportprogramsPrior authorizationupdates Credentialing How to file a coveragedetermination; electronicsubmission of priorauthorization requestsQuick ReferenceGuide2021 RegulatoryHighlights Guide Key contacts for priorauthorization requests Cultural competencyresources Medical health services;utilization, prior authorization,concurrent reviewPrevent payment delays: Updateyour addressPrompt payment is a priority for you and Cigna. Makesure we can find you; we receive 20,000 returnedchecks each year due to incorrect addresses. To updateyour mailing address: Cigna network providers: Contact your NetworkOperations Representative. Non-participating providers: Email an updated FormW-9 to PDM@Cigna.com.We continue to refine priorauthorization (PA) requirements toreduce administrative burden onproviders:Verify benefits and eligibilityfaster than ever As of October 1, 2021, 82 traumaand fracture codes in nonemergency settings were removed.(These codes never required PA inemergency settings.)Don’t want to wait in line? You can now verify patienteligibility, benefits and copayment amounts withoutholding for or speaking to a representative. Simply callour automated system: To date in 2021, 161 codeshave been removed from PArequirements.Call Provider Customer Service at 1-800-230-6138and select Option 3: Medical providerSelect Option 1: Verify eligibility,benefits or copaymentsClaim editing enhancementViewing claim code edits is easier with Clear ClaimConnectionTM (C3). This disclosure tool now incorporatesMedicare claims decisions and allows you to:Enter patient identification number to learneligibility dates, primary care physician orgroup and region information Enter Current Procedural Terminology (CPT ) and HealthcareCommon Procedure Coding System (HCPCS) coding scenarios Immediately access clinical edit rationales and edit sourcingFollow the prompts if you wish to hear thebenefits for a specific health care serviceAccess the tool at MedicareProviders.Cigna.com.10NETWORK INSIDER SNP MODEL OFCARE TRAININGMADE EASYIn less than 10 minutes, you can becompliant with the annual CMS-requiredSpecial Needs Plan Model of Care (SNPMOC) training requirement.* Cigna’s newtraining video and user-friendly attestationkeep the process simple.All Medicare Advantage contractedproviders have until December 31,2021 to complete the training. VisitCignaSNPTraining.com.Questions? Contact your NetworkOperations Representative.* The Centers for Medicare & Medicaid Services (CMS) requiresall contracted medical providers and staff to complete annualtraining on the Special Needs Plan Model of Care.FALL 202111
Medicare AdvantageNETWORKINSIDERFall 2021500 Great Circle RoadNashville, TN 37228 Name Address STAR RATINGSREFLECTEXEMPLARY CAREFor the fifth straight year, Cignarecorded the highest Star ratings forour Medicare Advantage (MA) plans: 89 percent of Cigna’s MAcustomers are in a four-Star ratedplan or higher for 2022. Our Florida HMO plan achieveda five-Star rating for the fourthstraight year.Medicare AdvantageNETWORKINSIDERThese scores reflect the excellentcare you provide your CignaMedicare patients. We appreciateyour partnership.Fall 2021All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation.The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. 2021 CignaINT 20 88965 C
patients with Cigna Medicare Advantage plan coverage. Your Cigna Medicare Advantage patients can access MDLIVE by calling 1-866-918-7836 (TTY 711) or by registering online for an MDLIVE appointment via myCigna.com. Questions? Contact Provider Customer Service or your Network Operations Representative. Monoclonal antibodies
