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Health disparitiesworsened byCOVID-19:Provider resourcesPage 3Quicker optionto submitpended claimdocumentationPage 9NetworkNewsLoweringmedication costsfor those withoutcoverageTHIRD QUARTER 2020For providersPage 14COVID-19 UPDATESWe’re committed to keeping you updated onhow we are supporting providers and customers.Visit the Cigna for Health Care Professionalswebsite (CignaforHCP.com) for the most currentinformation, including reimbursement, virtualcare options, and other guidelines.
NetworkNewsT H I R D Q UA R TER 2020ContentsFEATURE ARTICLEHealth disparities worsened by COVID-19: Provider resources . 3PHARMACY NEWSLowering medication costs for those without coverage .14Site of care review for pegfilgrastim products effective September 1 .15POLICY UPDATESExpansion of Specialty Medical Injectables withReimbursement Restriction list .15Preventive care services policy updates . 4Accredo to provide specialty home infusion services .16Clinical, reimbursement, and administrative policy updates . 5Market Medical Executivescontact information . 29Precertification updates . 7Digital connectivity capabilities through Accredo .17Updated Cigna Reference GuidesAvailable Fall 2020 .30Precertification of certain gastroenterology proceduresfor Individual & Family Plans . 7Oncology clinical consult service .17Use the network .30Transition to Express Scripts Pharmacy: Reminder.18Patient reviews reminders .31GENERAL NEWSQuick Guide to Cigna ID Cards:Interactive digital tool .31High-tech radiology site of care medical necessity review. 8ELECTRONIC TOOLSTips to prevent balance billing .19Quicker option to submit pended claim documentation . 9Important annual screenings . 20Coming soon: Online claims reconsideration requests . 9Physician quality and cost-efficiency reconsiderationrequests due August 10 .21Coming soon: Online benefit viewing throughprocedure code lookup . 10Cigna Gene Therapy Program .22Urgent carefor nonemergencies . 32View drug benefit details usingreal-time benefit check . 32Increase your knowledge withCareAllies education series . 33Webinar schedule for digital solutions. 11Final CMS regulations give patients greater control ofhealth care information .23CLINICAL NEWSCoordination of care .23Resources to enhanceinteractions with culturallydiverse patients . 33PPACA risk adjustment: Accurate claim coding maybenefit your patients .24Have you moved recently? Didyour phone number change? .34Medical record requests: Thank you for responding.25Cigna quality resources available online .25Get digital access to importantinformation . 35Appeals reminders.26Access the archives . 35Providers must meet language assistance compliance requirements .27Letters to the editor . 35Pap smears and bimanual pelvic exams underage 21 usually unnecessary .12QUALCARE NEWSNew QualCare section of Network News .13Updated policies and procedures available on the QualCare website .13QualCare and Qual-Lynx workers’ compensation COVID-19 updates .142Specialty medication prior authorization outreach program.16HELPFUL REMINDERSCIGNA NETWORK NEWS THIRD QUARTER 2020
CDC-recommended action steps for health care providersFEATURE ARTICLEThe CDC recommends that health care providers follow the action steps** listed below to help lessenhealth disparities.HEALTH DISPARITIES WORSENEDBY COVID-19: PROVIDER RESOURCESEven while the full impact of the coronavirus disease 2019 (COVID-19) pandemic on the well-beingof Americans still unravels, early data identified that there were racial and ethnic health disparities.For example:››Although Black/African Americans representedonly 18 percent of a community, theirhospitalization rate was 33 percent.*Death rates were much higher among Black/African Americans and Hispanic/Latino Americans(92.3 and 74.3 deaths per thousand, respectively)than for Caucasians and Asians (45.2 and 34.5deaths per thousand, respectively).*During crises such as the COVID-19 pandemic,minority groups are often overrepresented. It isthought this may be because of the worseningof the social determinants of health of thispopulation, such as their living conditions,employment environments, and underlyinghealth conditions.**ACTION STEPSRESOURCESIdentify andaddress implicitbias.CultureVisionCRCultureVision.com Login:CignaHCP, Password: Doctor123*Cultural competency training coursesCigna.com Health Care Providers Provider Resources CulturalCompetency and Health Equity Cultural Competency TrainingLanguage assistance services for interpretationand translation services. Discounted rates areavailable to Cigna-participating providers forwritten, telephonic, face-to-face, and videoremote interpretation services, includingAmerican Sign Language.Cigna.com Health Care Providers Provider Resources CulturalCompetency and Health Equity Language Assistance ServicesProvide medicalinterpretationservices.Reduce culturalbarriers to care.Connect patientswith communityresources to helpthem adhere totheir care plans.Learn moreabout socialdeterminants ofhealth that mayput some patientsat higher risk forgetting sick withCOVID-19.GO TO:TM››››Health disparities white papersCultural competency training coursesCultureVisionCigna.com Health Care Providers Provider Resources CulturalCompetency and Health EquityCultural competency assessmentsThe American Academy of Family Physicians(AAFP) website:›Neighborhood Navigator look-up tool (torefer patients to community resources)›Patient action plan (available in multiplelanguages)AAFP.org Patient Care TheEveryONE ProjectTM The EveryONEProject TOOLKIT Assessment andAction:››The EveryONE ProjectNeighborhood NavigatorAction Plan Development Tools›Network News article: Identifying andaddressing social determinants of health›Cigna.com Health Care Providers Provider Resources Cigna NetworkNews for Providers Network News:Second QuarterAAFP-validated screening tool to identifyand assist patients who may have unmetsocial needs›AAFP.org Patient Care TheEveryONE Project The EveryONEProject TOOLKIT Assessment andAction Social Needs Screening ToolsOffice of Disease Prevention and HealthPromotion websiteHealthyPeople.gov Topics &Objectives Social Determinants ofHealth Interventions and Resources* Shikha Garg, MD, et al. “Hospitalization Rates and Characteristics of Patients Hospitalized with Laboratory-Confirmed Coronavirus Disease 2019 – COVID-NET, 14 States, March 1–30, 2020.”CDC: Morbidity and Mortality (MMWR) Weekly Report. 17 April 2020. Retrieved from m?s cid mm6915e3 w.** “COVID-19 in Racial and Ethnic Minority Groups.” CDC website (CDC.gov) Coronavirus Disease 2019 More Info: Take Extra Precautions Other Populations: Racial and EthnicMinority Groups.3CIGNA NETWORK NEWS THIRD QUARTER 2020
POLICY UPDATESPREVENTIVE CARE SERVICESPOLICY UPDATESOn June 1, 2020, updates became effective for Cigna’s Preventive Care Services Administrative Policy A004.Summary: Preventive care updates effective on June 1, 2020DESCRIPTIONUPDATECODESHuman immunodeficiencyvirus (HIV) infectionscreeningAdded Current Procedural Terminology(CPT ) codes, which are covered aspreventive when submitted with a wellnessor maternity diagnosis80081, 86702, 87534, 87535,87536, 87806Sexually transmitted diseasescreening (chlamydia,gonorrhea, high-risk humanpapillomavirus [HPV])Added CPT codes, which are covered aspreventive when submitted with a wellnessor maternity diagnosis87800, 87801For additional guidance on preventive care services, refer to the Preventive Care Services AdministrativePolicy (A004) on the Cigna for Health Care Professionals website (CignaforHCP.com) Review coveragepolicies Medical and Administrative A-Z Index Preventive Care Services – (A004).4CIGNA NETWORK NEWS THIRD QUARTER 2020
POLICY UPDATESCLINICAL, REIMBURSEMENT, ANDADMINISTRATIVE POLICY UPDATESTo support access to quality, cost-effective care for your patients with a medical plan administered by Cigna, we routinely review clinical, reimbursement, and administrative policies for potential updates. As a reminder,reimbursement and modifier policies apply to all claims, including those for your patients with GWH-Cigna or “G” ID cards.Planned medical policy updates*POLICY NAMEDESCRIPTION OF SERVICEUPDATEEFFECTIVE DATECare IntegrationServices (R32)The Cigna Collaborative Care Code Reimbursement programis based on a CMS-developed collaborative care model. Itenhances primary care by adding care management supportfor customers receiving behavioral treatment, and includesregular psychiatric inter-specialty consultation with theprimary care teams.We have updated the Care Integration Services (R32) reimbursement policy to reimburse primary care providers(PCPs) when they perform the following: Provide care management support for patients with Cigna coverage whoare receiving behavioral health treatment, and coordinate that care through a behavioral health specialist.May 16, 2020 forclaims processedon or after thisdate.Intraoperative monitoring (IOM) is used to monitor theintegrity of neural pathways during surgical procedures whenthere may be risk of nerve injury.We will deny coverage for IOM and baseline electrodiagnostic procedures when performed during surgery at orbelow spinal level L1 as being medically unnecessary.IntraoperativeMonitoring(0509)To receive reimbursement for these services, providers must submit claims using Current Procedural Terminology(CPT ) code 99484, 99492, 99493, or 99494.August 16, 2020 fordates of service onor after this date.This update aligns with our current Intraoperative Monitoring (0509) medical coverage policy.National Correct The NCCI is a Centers for Medicare & Medicaid Services (CMS) We will update the NCCI editing for Facilities (R09) reimbursement policy to add additional code pairs to the codeCoding Initiatives program designed to prevent improper payment of procedure- pair list.(NCCI) editingto-procedure coding.This update will more closely align our policy to the CMS guidelines.for Facilities(R09)August 16, 2020 forclaims processedon or after this date.Nucleic AcidPathogenTesting (0530)August 16, 2020 fordates of service onor after this date.Nucleic acid testing is a type of lab test used to identify abacteria, yeast, or virus by detecting its genetic material. Anucleic acid pathogen panel is used to identify multiple virusesor bacteria at the same time, using one sample source.We will review tests for medical necessity in alignment with our Nucleic Acid Pathogen Testing (0530) medicalcoverage policy.This update does not include testing for COVID-19. Information about billing guidance for COVID-19 testing can befound on the Cigna for Health Care Professionals website (CignaforHCP.com).Continued on next page* Please note that the planned updates are subject to change. For the most up-to-date information, please visit CignaforHCP.com.5CIGNA NETWORK NEWS THIRD QUARTER 2020
POLICY UPDATESClinical, reimbursement, and administrativepolicy updates continuedPOLICY NAMEDESCRIPTION OF SERVICEUPDATEOmnibusReimbursementPolicy (R24)A prostate biopsy is used to detect cancer. A needle is inserted We will deny reimbursement for a prostate needle biopsy when billed with CPT code 88305.through the wall of the rectum and into the prostate to extract Claims may be resubmitted with the appropriate Healthcare Common Procedure Coding System (HCPCS) codecells for testing.G0416 with one unit.We will update the Omnibus Reimbursement Policy (R24) to address the coding issue.Additional informationCoverage policiesTo view our coverage policies, including an outline of monthly coverage policy changes and a fulllisting of medical coverage policies, visit CignaforHCP.com Review Coverage Policies.Modifier and reimbursement policiesTo view our reimbursement policies, log in to CignaforHCP.com. Go to Resources Reimbursementand Payment Policies Modifier and Reimbursement Policies. If you are not registered for thewebsite, go to CignaforHCP.com and click Register. If you do not have Internet access, and wouldlike additional information, call Cigna Customer Service at 800.88Cigna (882.4462).6CIGNA NETWORK NEWS THIRD QUARTER 2020EFFECTIVE DATEAugust 18, 2020 forclaims processedon or after thisdate.
POLICY UPDATESPRECERTIFICATION OF CERTAINGASTROENTEROLOGY PROCEDURESFOR INDIVIDUAL & FAMILY PLANSPRECERTIFICATION UPDATESTo help ensure that we are administering benefits properly, we routinely review our precertification policiesfor potential updates. As a result of a recent review, we want to make you aware that we have updated ourprecertification list.Codes added to the precertification list inJuly 2020Codes removed from the precertification listin July 2020On July 1, 2020, we added 23 new CurrentProcedural Terminology (CPT ) codes and 37 newHealthcare Common Procedure Coding System(HCPCS) codes.On July 1, 2020, we removed seven existing CPTcodes from the precertification list which no longerrequire precertification.On January 1, 2020, a precertification requirementfor the gastroenterology procedures listed belowwent into effect for most customers with CignaConnect Individual & Family Plans y (EGD)›Most capsule endoscopiesOur goal is to help assure customers that testsand procedures – which may be costly andpotentially harmful – are medically necessaryaccording to evidence-based guidelines. We havedelegated precertification of these services toeviCore healthcare.* Excludes patients covered by Cigna Connect Individual & Family Plans in Florida and Texas.To view an outline of these monthly precertification updates, as well as the complete list of servicesthat require precertification of coverage, log in to the Cigna for Health Care Professionals website(CignaforHCP.com) and click Precertification Policies under Useful Links. If you are not registered forthe website, go to CignaforHCP.com and click Register. If you do not have Internet access, and wouldlike additional information, please call Cigna Customer Service at 800.88Cigna (882.4462).7CIGNA NETWORK NEWS THIRD QUARTER 2020New coverage policiesWe implemented two new coverage policies tosupport this program.›Gastrointestinal Endoscopic ProcedureEsophagogastroduodenoscopy (EGD)›Gastrointestinal Endoscopic ProcedureCapsule EndoscopyYou can view these policies at eviCore.com/Cigna.CPT codesYou can find a full list of Current ProceduralTerminology (CPT ) codes associated with theseprocedures, as well as additional information aboutthe affected services, at eviCore.com/resources/healthplan/Cigna.
POLICY UPDATESHIGH-TECH RADIOLOGY SITE OFCARE MEDICAL NECESSITY REVIEWOn August 1, 2020, we will expand our precertification requirements for computed tomography (CT)scans and magnetic resonance imaging (MRI) to include a medical necessity review of the site of care. Thisrequirement applies for customers with fully insured benefit plans and those who are covered under theCigna employees benefit plan.*We review requests to ensure these customers receive coverage for an appropriate site of care, such as afreestanding facility, rather than an outpatient hospital setting (when available), except in situations where theuse of an outpatient hospital setting is medically necessary.**What this means to you and your patientswith Cigna planseviCore healthcare (eviCore) will approve:››Precertification requests that include anappropriate site of care, and are in accordancewith the terms of our coverage policy and thecustomer’s benefits.An outpatient hospital setting when medicallynecessary, as defined in the Site of Care: High-techRadiology policy and the customer’s benefit plan.Standard Cigna benefit plans will not cover a serviceor a site of service as medically necessary if there is alower-cost clinically equivalent alternative.How to submit precertification requestsYou can continue to submit precertification requestsfor these services to eviCore by logging in to theeviCore website (eviCore.com PROVIDERS).View the updated policyYou can access the updated Site of Care: High-techRadiology policy by going to the Cigna for HealthCare Professionals website (CignaforHCP.com) Getquestions answered: Resources Coverage Policies Policy Updates Policy Updates December 2019 Site of Care: High-tech Radiology – (0550).* We may not review the site of care in all geographic markets, pending regulatory approval and/or network considerations.** Some hospitals with competitive costs will be exempt from the site-of-care review.8CIGNA NETWORK NEWS THIRD QUARTER 2020
ELECTRONIC TOOLSCOMING SOON: ONLINE CLAIMSRECONSIDERATION REQUESTSQUICKER OPTION TO SUBMITPENDED CLAIM DOCUMENTATIONDid you know a faster option is now available whenyou need to submit supporting documentationwe’ve requested to process and pay a pended claim?Instead of mailing or faxing the information, you canupload and submit it through the Cigna for HealthCare Professionals website (CignaforHCP.com).Want to receive payments even more quickly?In addition to submitting attachments for pendedclaims electronically, you can help prevent delaysassociated with mailing or faxing claims by:›Sending initial claims and attachmentselectronically via the:When you use this feature, you’ll receivereimbursement for your pended claims more quickly.– ANSI* 837 Electronic Claims Submissiontransaction, andHow to use the new feature– ANSI* 275 Electronic Claim Attachmentstransaction.After logging in to CignaforHCP.com, conduct aclaim search. If you see that a claim is pended, youcan review the details to find out why. Click UploadSupporting Documentation in the Claim Detailssection to submit t
QUALCARE NEWS New QualCare section of Network News . 13 Updated policies and procedures available on the QualCare website . 13 QualCare and Qual-Lynx workers’ compensation COVID-19 updates . 1
