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E lectronic toolsBehavioral healthinformation and morenow on CignaforHCP.comICD-10 updatesThe Cigna for Health Care Professionals website (CignaforHCP.com)provides access to patient information, tools, and resourcesyou need when you need them. We’ve made enhancements tocontinue improving your electronic service experience with us.On January 6, 2014, Cigna began accepting paper claimssubmitted on the revised CMS 1500 Health Insurance ClaimForm (version 02/12). To provide health care professionals timeto transition to using this form, we will continue to accept andprocess paper claims submitted on the old CMS 1500 HealthInsurance Claim Form (version 08/05) for a period of time. Laterin 2014, we will notify you of the date when we will no longeraccept this form. Once that date is determined, you will need touse the revised (02/12) form to ensure accurate and promptclaim payments.Cigna Behavioral Health patient informationin one placeCignaforHCP.com is now the only Cigna website you need toperform tasks or find information for patients covered by aCigna Behavioral Health plan. You no longer have to log in toCignaBehavioral.com to access tools, information, and real-timetransactions. Just go to CignaforHCP.com to verify eligibility andbenefits, check the status of a claim, and view important policyand procedure information for all your Cigna behavioral patients.Cigna Cost of Care Estimator for more plansYou can now use the Estimator for your patients covered by CignaBehavioral Health and those with GWH-Cigna ID cards.The Cigna Cost of Care Estimator can help your patientsunderstand what out-of-pocket expenses they may be expectedto pay based on their Cigna-administered plan benefits. Itprovides itemized cost estimates and explains the sources ofpayment, including anticipated payments from your patient’shealth account (HRA, HSA, FSA) when automatic claimforwarding is enabled and applicable to their plan. It can alsohelp facilitate proactive pre-care financial discussions betweenyou and your patients.Use the Cigna Cost of Care Estimator today. Log in to CignaforHCP.com Patients Search Patients Select a Patient Estimate Costs.Not registered for CignaforHCP.com?Visit CignaforHCP.com and click “Register Now.”We want you to be aware of the following changes as weapproach the October 1, 2014 ICD-10 compliance date.Paper claim submission – revised CMS 1500Non-billable codes no longer acceptedAs a reminder, effective October 2013, we no longer acceptnon-billable ICD codes. A non-billable ICD-9 or ICD-10 code isdefined as a code that has not been coded to its highest levelof specificity.TestingWe held successful clearinghouse and vendor testing in October2013 to help ensure we could correctly receive and send files,transactions, and codes. We will be performing additional testingthrough February 2014. We expect to complete testing with 30 to35 vendors and clearinghouses by March 2014.DRG inpatient hospital studyOur diagnosis related group (DRG) inpatient hospital study isunderway and will continue through the second quarter of 2014.This study will provide insights to inpatient hospital codingpractices and how it affects payment. This collaborative processis underway with selected Cigna participating health careprofessionals to analyze claims with ICD-9 and ICD-10 coding.We plan to analyze and release the study results once the datais available.Upcoming webinars and other ICD-10 resourcesWe will be hosting ICD-10 webinars throughout 2014. In addition,self-study materials are available to help you understand andprepare for the ICD-10 upgrade. For webinar dates, sign-upinformation, and to access the self-study materials, log in toCignaforHCP.com Resources Medical Resources ICD-10.4cigna Network News january 2014

E lectronic toolsImprove claim processing andreduce payment delaysEnsuring your claims are submitted with accurate information helps improve claimprocessing and reduces payment delays. Always enter your patient’s demographicinformation on the claim exactly as it appears on his or her Cigna ID card to helpprevent claim rejections.Below are some examples of messages you may receive on a rejected claim, andwhat you should do to help ensure the claim is processed correctly.Error/issueResolution/correctionPatient ID not correctReview the patient’s current ID card to ensure correct values are submitted.For the most accurate patient match results, submit the complete patient ID,including the extension, as shown on the patient’s ID card.Incorrect use of extension(01, 02, 03, etc.)Cigna ID cards include a two-digit number (e.g., 01 or 02) at the end of the patient ID.This ID card extension confirms whether the patient is the subscriber or a dependent.The 01 extension usually indicates the subscriber; any other extension indicates thepatient is a dependent.Newborn not on fileConfirm that the subscriber has added a newborn to their policy.Patient billed as subscriberConfirm that the patient is the subscriber.Date of birthConfirm the patient’s date of birth.Subscriber no longer eligibleCheck the patient’s eligibility and verify coverage effective and termination dates.AddressConfirm that the patient’s address is correct.When submitting a dependent claim, confirm if the address is the same or differentthan the subscriber.Hyphenated namesIf the patient’s name contains a hyphen, include it in the claim.Claim submitted for medical coveragewhen patient or subscriber only hasdental coverageConfirm the patient is eligible for the type of service being rendered.Spelling mistakes or incorrectlykeyed informationCheck for spelling mistakes.First and last name included in same fieldFirst name should be in the “First Name” field, last name in the “Last Name” field.If a patient has a dual first name, verify if the name has a space or no space (e.g., BillyJoe versus BillyJoe; or BobbySue versus Bobby Sue). The patient name on the claimmust be submitted exactly as shown on the patient’s ID card.cigna Network News january 20145

E lectronic toolsElectronic funds transfer enhancementsElectronic funds transfer (EFT), also known as direct deposit,electronically deposits a claims fee-for-service and capitatedpayments directly into your bank account. It enables you toreceive your claim payments faster, helping improve your officeworkflow and shorten the payment cycle.We currently provide EFT for our PPO, OAP and HMO claimreimbursements. We are excited to announce that we’ve mademore options available to you through Cigna EFT.Bulk your EFT payments by NPIIf you are enrolled in EFT with Cigna, your payments are groupedor bulked based on your Taxpayer Identification Number (TIN)and payment address. Now you have the additional option tobulk your payments by your Billing Provider National ProviderIdentifier (NPI) from your submitted claims.To have your EFT payments bulked by NPI, log in toCignaforHCP.com Working with Cigna Manage EFT Settings.You’ll be able to update your payment preferences from this page.EFT for additional Cigna productsIn addition to having the option of bulking your payments byeither your TIN or NPI, you can also receive EFT payments forservices you provide to patients covered through Cigna GlobalHealth Benefits and Arizona Medicare Advantage HMO plans. Youwill automatically begin receiving these payments electronicallyif you are already enrolled for Cigna EFT.Please note that EFT payments are not currently available forpatients with GWH-Cigna ID cards. EFT payments and bulkingoptions will be available for patients with GWH-Cigna ID cardslater in 2014.Not enrolled in EFT?If you are not enrolled for EFT with Cigna, you have two optionsto enroll: Enroll in EFT directly with Cigna by logging in toCignaforHCP.com Working with Cigna Enroll inElectronic Funds Transfer (EFT) Options. Enroll in EFT with multiple payers, including Cigna, using theCouncil for Affordable Quality Health Care (CAQH) website.6cigna Network News january 2014Easily access your remittance reportsIf you are enrolled in EFT with Cigna, and are registered forCignaforHCP.com with access to claims status inquiry, you caneasily access your remittance reports for your payments. Log in to CignaforHCP.com Remittance Reports Search for your remittance reports using a few options:- Deposit amount- Patient information- Claim/Reference numberNot registered for the website? Go to CignaforHCP.com and click “Register Now” For step-by-step registration directions, click“Learn how to register”

health care reform newsMarketplaces and essential health benefitsNew provisions of the Patient Protection and Affordable Care Act (PPACA) became effective on January 1, 2014. The HealthInsurance Marketplaces (“Marketplaces”) and essential health benefits provisions may affect you and your patients directly.Health Insurance MarketplacesMarketplaces, also known as publicexchanges, are government-run shoppinghubs that are now operating in everystate as a new option for individualsand small employers with 50 or feweremployees to compare and purchasemedical and dental health insurance.Depending on an individual’s incomelevel, and access to an affordableemployer-sponsored plan, subsidiesmay be available for individual policiespurchased on the Marketplace, or“on-Marketplace.”Cigna participates withproducts on-MarketplaceTypes of plans offered on-andoff-MarketplaceEssential health benefitsWe will offer individuals health plansat three different levels – Bronze, Silver,and Gold – on the Marketplaces inthese five states. Plans sold throughMarketplaces are categorized usingthese metal designations to representthe percent of expenses each plan willcover. For example, a bronze plan willcover 60 percent of covered plan costs,whereas a gold plan will cover 80 percent.Cigna Marketplace plans will use ourLocalPlus network.Cigna will also sell private“off-Marketplace” individual plans in thefive on-Marketplace states, as well as inCalifornia, Connecticut, Georgia, NorthCarolina, and South Carolina. Our privatelysold individual and family plans in all tenstates use the Open Access Plus Network.Cigna is offering individual Marketplaceproducts in five states: Arizona (Phoenix and statewide) Colorado (Denver) Florida (South Florida, Orlandoand Tampa) Tennessee (Chattanooga,Memphis and Nashville) Texas, (Austin, Dallas and Houston)PPACA requires non-grandfathered,1insured, individual, and small groupplans (1–50 employees in 2014, and1–100 employees in 2016) to provideten basic categories of essential healthbenefits. This core set of benefits providesconsumers with a consistent way tocompare health plans in the individualand small group markets, both on-andoff-Marketplace.There are ten essential healthbenefits categories: Cigna’s participation on Health Insurance Marketplaces Ambulatory patient servicesEmergency servicesHospitalizationLaboratory servicesMaternity and newborn careMental health and substanceuse disorders and behavioralhealth treatmentPrescription drugsPediatric services, including oraland vision carePreventive and wellness servicesand chronic disease managementRehabilitative and habilitativeservices and devicesCTCOCANCTNAZSCGATXFLOff MarketplaceOn and Off Marketplacecigna Network News january 20147

health care reform newsMarketplaces and essential health benefits (continued from page 7)New annual and lifetime dollarmaximum limitationsStarting January 1, 2014, annual and lifetime dollar maximumlimits are no longer allowed on essential health benefits whencovered in-network. However, frequency limits,2 such as day orvisit limits, are allowed. This requirement applies to all size plans(individual, small group, and large group) whether insured orself-insured, including grandfathered plans.Essential health benefits vary by stateThe services that are defined as essential health benefits withinthe ten basic categories are based on state benchmark plans.Each state was required to select an existing health plan asa “benchmark” to establish the services and items includedin the essential health benefits package for 2014 and 2015.Small group plans are the benchmarks in 85% of states. VisitInformedOnReform.com (Essential Health Benefits Top 10 EHB by State) to see a listing of the benefits thatcommonly vary by state.Out-of-pocket maximum changesAs part of the essential health benefits provision, in-network,out-of-pocket (OOP) maximums in non-grandfathered planscannot exceed 6,350 for individuals, or 12,700 for familiesbeginning on January 1, 2014. OOP maximums apply to allin-network copays, deductibles, and coinsurance for essentialhealth benefits provided through the same payer or vendor. Thisis different than in the past, as copays and deductibles oftendidn’t apply toward the out-of-pocket maximum.Verify patient coverageDue to the OOP maximum change, it will be important that youverify a patient’s eligibility and benefits before collecting anycopays or coinsurance. Be sure to use one of these options toverify your patient’s coverage: Visit the Cigna for Health Care Professionals website(CignaforHCP.com) Use the electronic data interchange (EDI) eligibilityand benefit inquiry and response Call 1.800.88Cigna (882.4462). For patients with aGWH-Cigna ID card, call 1.866.494.2111.Helping you stay informedWe update InformedOnReform.com regularly so that youhave access to the most current information about the PPACAprovisions and changes affecting you and your patients. Help usto provide you with the health care reform information you needby sending suggestions to NetworkNewsEditor@Cigna.com.1 A non-grandfathered plan is a group health plan that was not in place when PPACA was signed intolaw on March 23, 2010, or a plan that was in effect but has since made changes which caused it to loseits grandfathered status.2 Frequency limits such as “20 visits” are allowed provided there isn’t also a dollar limit associated withthe visits, such as “20 visits at 50 maximum payout per visit” which would not be allowed.8cigna Network News january 2014

health care reform newsMedical record reportingRisk adjustment is a component of the Patient Protection and Affordable Care Act (PPACA) that is dependent on reporting accurateclinical information. According to PPACA, health plan carriers are required to provide diagnostic information to the Centers forMedicare & Medicaid Services (CMS) for all customers who enroll in their individual and family plan business through the Public HealthInsurance Marketplace. The CMS then reviews the diagnostic information and determines the plan’s average risk. The average riskscore is compared against that of other health plans participating in the same states and markets. If there are any health plan carrierswith a disproportionately higher risk score, CMS requires that those carriers with lesser risk compensate the ones with higher risk.Importance of documentationTo ensure Cigna and CMS receive accurate information, youshould always document and report treatment associated withthe management of all medical conditions within the medicalrecord. This will help ensure accurate diagnostic information isreported to the CMS. Code all conditions that exist at the time ofthe visit. All active chronic conditions should be documented inyour patient’s medical record as active at least once annually.Medical records reviewReviewing medical chart documentation helps identifyconditions that may have been evaluated and included in thepatient’s progress notes, but were not included on the claimat the time of the visit. To help ensure we are meeting the newPPACA requirements, we have asked Altegra Health to assist usin conducting medical record reviews on an as-needed basisso we can report all diagnostic information to CMS as required.Health care professionals contacted by Altegra Health will beasked to submit specific patient medical records to ensure theservices and treatments provided were fully documented withinthe medical record. Details on how to submit the medical recordswill be provided by Altegra Health.Thank you in advance for helping us provide CMS withaccurate information.cigna Network News january 20149

G E N E R A L N E WSPPO/OAP National-Level Performance2013 National RankingsNCQAnational healthinsurance planrankings:Total Number of Cigna PPO/OAP plans in top 501Total Number of Cigna PPO/OAP plans in top 1002Total Number of Cigna PPO/OAP plans in top 20016HMO/POS National-Level Performance2013 National RankingsTotal Number of Cigna HMO/POS plans in top 1004How did we do?Total Number of Cigna HMO/POS plans in top 20012Once again, Cigna has some of the bestplans in the country. For the last nineyears, the National Committee for QualityAssurance (NCQA) has released nationalrankings on insurance plans. For the2013–2014 period, some of our highestranking areas include one of our PreferredProvider Organization/Open Access (PPO/OAP) plans in nine of the 38 marketswhere we were ranked. A total of four ofour Health Maintenance Organization/Point of Service (HMO/POS) plans areranked among the top 100 plans in thenation. This success continues to showour commitment to responsive customerservice and providing access to quality care.PPO/OAP Market-Level Performance: Top Performing MarketsAbout the rankingsThe NCQA rankings are released inConsumer Reports and on NCQA’swebsite. The NCQA’s Health InsurancePlan Rankings1 are based on NCQA’smeasurement of a health plan’sperformance in three categories:Improving health care quality,providing responsive customer serviceand achieving high scores on NCQAaccreditation surveys. Additionally, thereis a companion report, the State of HealthQuality, which profiles how health plansrate on HEDIS clinical care measures andcustomer satisfaction (CAHPS ).Please see the following tablesfor a complete overview ofCigna’s NCQA rankings:1. Scoring based on HEDIS and CAHPS data that was submitted toNCQA in June 2012 and the plan’s Accreditation standards scoreas of July 29, 2012.10cigna Network News Cigna Health and Life Insurance Company – ArizonaCigna Health and Life Insurance Company – IllinoisCigna Health and Life Insurance Company – MaineCigna Health and Life Insurance Company – MarylandCigna Health and Life Insurance Company – MissouriCigna Health and Life Insurance Company – OregonCigna Health and Life Insurance Company – South DakotaCigna Health and Life Insurance Company – TennesseeCigna Health and Life Insurance Company – WashingtonCigna Health and Life Insurance Company – ArizonaHMO/POS Market-Level Performance: Top Performing MarketsCigna HealthCare of ArizonaCigna HealthCare of New JerseyCigna HealthCare of North CarolinaAlliance PartnerNational RankingState RankingTufts Health Plan(HMO/POS)6Massachusetts–3Tufts Health Plan (PPO)8Massachusetts–2Rhode Island–1MVP Health Care53New sconsin–1Health Alliance Plan ofMichigan56Michigan-4january 2014

G E N E R A L NE WSReminder:LocalPlusproductexpandedAs a reminder, we began offeringour LocalPlus product in additionalmarkets on January 1, 2014. LocalPlus isa managed care product suite designedto include a smaller network of Cignaparticipating health care professionalsand hospitals. These plans are a solutionfor employers who want to control costswithout sacrificing access to quality or avariety of services.Initially launched in Tennessee andHouston, Texas, LocalPlus is offered in 10additional markets as of January 1, 2014: Austin, TexasChicago, IllinoisDallas, TexasDenver, ColoradoNorthern California (Alameda,Contra Costa, San Francisco, SanMateo, and Santa Clara counties) Orlando, Florida Phoenix, Arizona Southern California (Los Angeles,Orange, San Bernardino, Riverside,and San Diego counties) South Florida (Broward, Martin,Miami-Dade, Monroe, Palm Beach,and St. Lucie counties) Tampa, FloridaSome of your patients may be startingto present their new LocalPlus ID card.Please be sure to reference the cards todetermine where to submit claims, andwho to call for customer service andbenefits information.New cultural competencytraining and resourcesIn today’s cross-cultural society, your patients have many diverse values, beliefs

cigna network news january 2014 1 GENERAL NEWS Cigna to apply McKesson ClaimsXten code editing software in February 2014 On February 17, 2014, we will begin using . Cigna Sleep Management Program update 13 Coordination of benefits for Medicare primary claims 13 Supporting your patents during disability 14