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CIGNA-HEALTHSPRINGCLAIMS SUBMISSIONINSTRUCTIONSConfidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. 2016 Cigna
HOW TO AVOIDMISDIRECTED CLAIMSConfidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. 2016 Cigna2
Objective: 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to customers, providers,and Cigna-HealthSpring Assist in a service improvement to providers and customersConfidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. 2016 Cigna3
Acronyms C-HS – Cigna-HealthSpring EDI -Electronic Data Interchange IVR - Interactive Voice Response PCP – Primary Care Provider FDR – First Tier Downstream and Related EntityConfidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. 2016 Cigna4
MISDIRECTED CLAIMSConfidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. 2016 Cigna5
Overview:We recently enhanced our process for redirecting claims sent to the C-HS offices inerror. While we are redirecting these claims timely, to assist our providers we created achecklist to help in identifying proper submission of claims to the entity responsible forclaims processing and payment.Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. 2016 Cigna6
Checklist: Check Customer’s ID Card View HSConnect Portal Connect to the IVR Contact the Provider Service line Identify the Customer’s Provider NetworkConfidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. 2016 Cigna7
CUSTOMER ID CARDConfidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. 2016 Cigna8
Customer ID Card - IntroductionProviders are encouraged to check Cigna-HealthSpring customer’s ID cards for guidanceon proper claims submission.Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. 2016 Cigna9
Customer ID Card (Front)The front of the customer’s ID card will contain the following information: Plan Name RxBIN Health Plan RxPCN Customer Name Contract & PBP Number PCP Name Copays: PCP Phone PCP Network Specialist ER Urgent CareConfidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. 2016 Cigna10
Customer ID Card (Front) One of the fields on the ID card that can assist providers with proper claimsubmissions is “Network.” A customer’s Network may sometimes help providers determine the entityto which the claims should be submitted to:Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. 2016 Cigna11
Customer ID Card (Back)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 WebsiteConfidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. 2016 Cigna12
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 inthe claim.Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. 2016 Cigna13
CLAIM SUBMISSIONConfidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. 2016 Cigna14
Mailed/Electronic Claims SubmissionThe following sections will show the proper claims submission information where paperand Electronic Data Interchange (EDI) claims can be submitted. This is determined byidentifying the network the provider is participating in for Cigna-HealthSpring customers.Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. 2016 Cigna15
NETWORKSConfidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. 2016 Cigna16
Network IdentificationThe following information will assist you in identifying the appropriate address for mailedclaims 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 withclaims processing.Tip: The network is stated on the front of the customer ID Card.Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. 2016 Cigna17
IPA / Independent Entity(if applicable)Claims MailingAddressAlabamaN/ACigna-HealthSpringP.O Box 981706El Paso, TX 79998AlabamaBaldwin Physician NetworkCullman Primary Care IPADallasEtowahEast Jefferson (JEST)Franklin Medical NetworkLittle River CanyonPrinceton Premier IPAProvidence Medical NetworkRed MountainRiver RegionShelby ChiltonSouthern Medical PhysiciansSummit WestSynergyTallacoTennessee ValleyWalkerWest AlabamaC-HS MarketConfidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. 2016 CignaPlease Insert IPA NameP.O Box 981706El Paso, TX 7999818
C-HS MARKETSIPA / Independent Entity(if applicable)Claims Mailing AddressAlabama(Southern Mississippi) (SMS)Hattiesburg IPALighthouse IPAPlease Insert IPA NameP.O Box 981706El Paso, TX 79998Alabama(Georgia) (Atlanta)CAAP Health Network IPACAAP Health Network IPAP.O Box 981706El Paso, TX 79998GeorgiaN/ACigna-HealthSpringP.O Box 981706El Paso, TX 79998Illinois (Medicare Advantage)Advocate Health CentersAdvocateP.O. Box 0522Mount Prospect, IL 60056IllinoisHealth SelectMedical Care GroupPlease Insert IPA NameP.O Box 981706El Paso, TX 79998Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. 2016 Cigna19
C-HS MARKETSIPA / Independent Entity(if applicable)Claims Mailing AddressIllinoisSwedish Covenant ManagedCareSCMCA2740 W. Foster Ave.,Ste 409Chicago, IL 60625IllinoisUniversity of ChicagoUniversity of Chicagoc/o MPASP.O. Box 3358Glen Ellyn, IL 60138Missouri (Kansas City)N/ACigna-HealthSpringP.O Box 981706El Paso, TX 79998Mid-AtlanticDC Qual-Care IPATrendsetter IPAPlease Insert IPA NameP.O Box 981706El Paso, TX 79998Mid-AtlanticN/ACigna-HealthSpringP.O Box 981706El Paso, TX 79998Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. 2016 Cigna20
C-HS MARKETSIPA / Independent Entity(if applicable)Claims Mailing AddressMid-Atlantic(Pennsylvania)Ben Franklin Physicians IPABroad Spectrum IPADelco Wellness IPALiberty Independent PhysiciansGroupPrestige Physician GroupPlease Insert IPA NameP.O Box 981706El Paso, TX ngP.O Box 981706El Paso, TX 79998North CarolinaN/ACigna-HealthSpringP.O Box 981706El Paso, TX 79998South CarolinaN/ACigna-HealthSpringP.O Box 981706El Paso, TX 79998TennesseeSynergy HealthCare, LLCClarksville Medical NetworkEast Memphis Medical NetworkHCA - TriStar Medical NetworkKMGMemphis Midtown IPAPlease Insert IPA NameP.O Box 981706El Paso, TX 79998Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. 2016 Cigna21
C-HS MarketsIPA / Independent Entity(if applicable)Claims Mailing AddressTennesseeNorth Tennessee MedicalNetworkPremier IPARutherford CountyScenic City IPAPlease Insert IPA NameP.O Box 981706El Paso, TX 79998TennesseeN/AConfidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. 2016 CignaCigna-HealthSpringP.O Box 981706El Paso, TX 7999822
C-HS MarketsTexasTennesseeTexasTexasTennesseeTexasIPA / Independent Entity(if applicable)Claims Mailing AddressN/A MedicalNorth TennesseeNetworkPremier IPARutherford CountyScenic City IPAEl Paso Integral Care (EPIC)Cigna-HealthSpringP.O Box 981706El Paso,TXIPA79998PleaseInsertNameP.O Box 981706El Paso, TX 79998El Paso Integral CareP.O Box 981706El Paso, TX 79998Prospect Medical GroupN/AProspect Medical ntaElAna,CATX92711-14466Paso,79998WellMedWellMed ClaimsP.O. Box 400066San Antonio, TX 78229Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. 2016 Cigna23
C-HS MARKETSIPA / Independent Entity(if applicable)Claims Mailing AddressTexasRenaissance PhysicianRenaissance PhysicianOrganizationAttn: ClaimsP.O. Box 2888Houston, TX 77252-2888OrganizationTexasValley Organized PhysiciansConfidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. 2016 CignaValley Organized PhysiciansClaimsP.O Box 981706El Paso, TX 7999824
ELECTRONIC DATAINTERCHANGE (EDI) CLAIMSConfidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. 2016 Cigna25
Electronic Data Interchange (EDI)EDI is the most common and preferred method of claims submission by providers.Cigna-HealthSpring has direct connections with the following clearinghouses forsubmission of EDI claims.Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. 2016 Cigna26
Clearing Houses: All MarketsAll Cigna-HealthSpring providers can use the following l, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. 2016 CignaMcKession/Relay27
Clearing House & Payer ID:Tennessee, Texas, Alabama, Illinois The following clearing houses and payer ID can be used for the TN,TX, AL, IL markets.Clearing HousePayer IDChangeHealthcare63092SSI Group63092Proxymed (Caprio) 63092OfficeAlly63092Availity63092RelayCPID2795 (Professional Claims)CPID1556 (Institutional Claims)Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. 2016 Cigna28
Clearing House & Payer ID:Georgia, South Carolina, North Carolinaand Missouri The following clearing houses and payer ID can be used for the GA,SC, NC and MO markets.Clearing HousePayer IDChangeHealthcare52192SSI Group63092Proxymed (Caprio) 63092OfficeAlly63092Availity63092RelayCPID2795 (Professional Claims)CPID1556 (Institutional Claims)Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. 2016 Cigna29
Clearing Houses: Mid-Atlantic and Pennsylvania market The following clearing houses and payer ID can be used for the Mid –Atlantic and Pennsylvania markets.Clearing HousePayer IDChange Healthcare52192Availity63092RelayCPID 3839(Professional)CPID 1978(Institutional)Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. 2016 Cigna30
Renaissance PHYSICIAN ORGANIZATION (RPO): Renaissance EDI claim can be submitted using the following clearinghouses and payer ID’s:Clearing HousePayer IDAvailityTHS01, HER01ChangeHealthcare33104 (Texas HealthSpring)(HealthSpring Life & Health InsuranceCompany)ChangeHealthcare76066 (Renaissance PhysiciansOrganization)Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. 2013 Cigna31
HS CONNECTConfidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. 2016 Cigna32
HSConnectHSConnect Portal allows participating providers access to the information and toolsneeded to make their interaction with Cigna-HealthSpring more efficient such asverification of customer’s provider network in order to determine claim submissionaddresses and vendors.Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. 2016 Cigna33
HSConnect In HSConnect providers can determine where to submit the claims based on theCustomer Region. The “Customer Region” displays the network a customer is in, which can assist indetermining claims submission.Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. 2016 Cigna34
INTERACTIVE VOICE RESPONSE(IVR)Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. 2016 Cigna35
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 HealthConfidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. 2016 Cigna36
IVR – Claim SubmissionWhen calling the IVR, providers can check a customer’s provider network to determineclaim 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 CustomerID Card.Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. 2016 Cigna37
PROVIDER SERVICECALL CENTERConfidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. 2016 Cigna38
Provider Call CenterCigna-HealthSpring’s Provider Call Center 1-800-230-6138 can perform thefollowing functions: Verify Benefits Claims status Claim Submissions Customer Eligibility Check Tracers Low service timeThe provider customer service call center is available Monday through Friday from7:00 a.m. to 6:00 p.m. CST.Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. 2016 Cigna39
IMPACT TO CUSTOMERS,PROVIDERS, ANDCIGNA-HEALTHSPRINGConfidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. 2016 Cigna40
Impact on CustomersInappropriate submission of claims will impact Cigna-HealthSpring customers in manyways. Below are a few examples: Bills Customer’s may receive a bill from a provider who has not received payment fora claim that was misdirected to Cigna-HealthSpring’s claim department insteadof the network (FDR) responsible for claims processing and payment. Letters & Calls Cigna-HealthSpring customers may also receive letters from providers askingthem to contact the health plan because they have not received payment.Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. 2016 Cigna41
Impact on ProvidersInappropriate submission of claims can also have an impact on Cigna- HealthSpringproviders. Here is a key example of this: Delay of Payment When a claim is misdirected to Cigna-HealthSpring it may cause a delay in thetimely processing of the claim. A delay in processing the claim timely can then result in the delay of payment toour providers.Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. 2016 Cigna42
Impact on Cigna-HealthSpringCigna-HealthSpring customers and providers are the key to our health plan’s success.Misdirected claims causes an adverse impact on both customers and providers. Westrive for customer and provider centricity every day. Customer Disenrollment: As a result of receiving bills, calls and letters from providers who have notreceived payment for a service, customers may request to disenroll fromCigna-HealthSpring. Provider Relationship: Providers who do not receive timely payment as a result of misdirected claimsmay become frustrated and may elect not to renew their contract with C-HS.Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. 2016 Cigna43
Thank you for your participation in theCigna-HealthSpring Medicare Advantage networkAll 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 subsidiariesof 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.
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
