For provider use only868268 g 09/17

ID CARDREFERENCE GUIDE

2018

1 Use this ID number for all claims and inquiries.

2 Issuer: This number is the same for all Cigna customers.

3 Name of patient‘s primary care physician (PCP).

4 RxBIN/Rx PCN: Pharmacies use these number to identify Cigna customers.

5 Rx Group: Internal identifier for Cigna customers.

6 POD: Provider group/specialist identifier.

7 Collect any copayment at the time of service.

8 PBP: Plan ID number assigned by Medicare.

9 Payor ID: For medical claims purposes.

10 Submit claims to the claim submission address shown on the card.

Key

For provider use only

Cigna-HealthSpring Achieve Plus (HMO SNP)

Cigna-HealthSpring Preferred (HMO)

The images shown below are examples only and may not reflect actual plan copay amounts.

Customer Service: 800-627-7534Mental Health/Substance Abuse: 800-866-6534TTY: 711Payor ID: 62308

Medical Claims:Cigna Medicare ServicesPO Box 38639Phoenix, AZ 85069

Pharmacy Claims:Cigna Medicare ServicesAttn: DMRPO Box 20002Nashville, TN 37202 www.cignahealthspring.com

To speak with a registered nurse, call the Cigna Health Information Line at 800-356-0665, after business hours when your doctor’s office is closed.This card does not guarantee coverage.

9

10

S A M P L E

PBP 021

Contract H0354/2018

Name Joe CustomerID # U0123456789Issuer 80840PCP Dr. John SmithPCP Phone 602-123-4567RxBIN 017010RxPCN CIHSCARERxGroup 4010MRPOD 9CSD

PCP $0Specialist $25Emergency $80Urgent Care $0Vision $25

S A M P L E1

2 7

4

5

3

6 8

Customer Service: 800-627-7534Mental Health/Substance Abuse: 800-866-6534TTY: 711Payor ID: 62308

Medical Claims:Cigna Medicare ServicesPO Box 38639Phoenix, AZ 85069

Pharmacy Claims:Cigna Medicare ServicesAttn: DMRPO Box 20002Nashville, TN 37202 www.cignahealthspring.com

To speak with a registered nurse, call the Cigna Health Information Line at 800-356-0665, after business hours when your doctor’s office is closed.This card does not guarantee coverage.

9

10

S A M P L E

PBP 021

Contract H0354/2018

Name Joe CustomerID # U0123456789Issuer 80840PCP Dr. John SmithPCP Phone 602-123-4567RxBIN 017010RxPCN CIHSCARERxGroup 4010MRPOD 9CSD

PCP $0Specialist $30Emergency $80Urgent Care $25Vision $30

12 7

4

5

3

6 8S A M P L E

For provider use only

Independent Provider Network POD ID

Independent Provider Network POD Name

911D Health Choice Preferred (HCP)

911E Arizona Care Network (ACN)

911G West Phoenix IPN

911H Scottsdale IPN

911J Southeast IPN

911K Arizona Primary Care (APC)

MIPA AZ IPN Wickenburg

INST AZ IPN Optum

Independent Provider Network POD ID Independent Provider Network POD Name

91TD Carondelet Physicians

91TE Tucson

91TF Northwest Allied Physicians

Maricopa County PODs

Pima County PODs

Cigna Medical Group POD ID

Cigna Medical Group POD Name

9CNW Northwest ArrowheadNorth Valley Paseo

9CSD NortheastParadise ValleyScottsdaleScottsdale Norte

9CEP EastRed MountainQueen CreekStapleySuperstition Springs

9CSE SoutheastChandlerCJ HarrisSan Tan

9CCP CentralPhoenix CentralPointeSouth Mountain

9CSW SouthwestPalm ValleyWestridge

9CSC Sun CitySun CitySun City West

All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna HealthCare of Arizona, Inc. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. Cigna-HealthSpring is contracted with Medicare for PDP plans, HMO and PPO plans in select states, and with select State Medicaid programs. Enrollment in Cigna-HealthSpring depends on contract renewal. All pictures are used for illustrative purposes only.

868268 g 09/17 © 2017 Cigna. Some content provided under license.