CIGNA-HEALTHSPRING CLAIMS SUBMISSION INSTRUCTIONS
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna
HOW TO AVOID MISDIRECTED CLAIMS
2 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna
• 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 customers
Objective:
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C-HS – Cigna-HealthSpring
EDI -Electronic Data Interchange
IVR - Interactive Voice Response
PCP – Primary Care Provider
FDR – First Tier Downstream and Related Entity
Acronyms
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MISDIRECTED CLAIMS
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We recently enhanced our process for redirecting claims sent to the C-HS offices in error. While we are redirecting these claims timely, to assist our providers we created a checklist to help in identifying proper submission of claims to the entity responsible for claims processing and payment.
Overview:
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Check Customer’s ID Card
View HSConnect Portal
Connect to the IVR
Contact the Provider Service line
Identify the Customer’s Provider Network
Checklist:
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CUSTOMER ID CARD
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Providers are encouraged to check Cigna-HealthSpring customer’s ID cards for guidance on proper claims submission.
Customer ID Card - Introduction
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The front of the customer’s ID card will contain the following information:
• Plan Name
• Health Plan
• Customer Name
• PCP Name
• PCP Phone
• Network
Customer ID Card (Front)
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• RxBIN
• RxPCN
• Contract & PBP Number
• Copays:
• PCP
• Specialist
• ER
• Urgent Care
• One of the fields on the ID card that can assist providers with proper claim submissions is “Network.”
• A customer’s Network may sometimes help providers determine the entity to which the claims should be submitted to:
Customer ID Card (Front)
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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
• Website
Customer ID Card (Back)
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• 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 in
the claim.
Customer ID Card (Back)
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CLAIM SUBMISSION
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The following sections will show the proper claims submission information where paper and Electronic Data Interchange (EDI) claims can be submitted. This is determined by identifying the network the provider is participating in for Cigna-HealthSpring customers.
Mailed/Electronic Claims Submission
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NETWORKS
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The following information will assist you in identifying the appropriate address for mailed claims 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 with claims processing. Tip: The network is stated on the front of the customer ID Card.
Network Identification
17 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna
18 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna
C-HS Market IPA / Independent Entity (if applicable)
Claims Mailing Address
Alabama
N/A
Cigna-HealthSpring P.O Box 981706
El Paso, TX 79998
Alabama
Baldwin Physician Network Cullman Primary Care IPA
Dallas Etowah
East Jefferson (JEST) Franklin Medical Network
Little River Canyon Princeton Premier IPA
Providence Medical Network Red Mountain River Region
Shelby Chilton Southern Medical Physicians
Summit West Synergy Tallaco
Tennessee Valley Walker
West Alabama
Please Insert IPA Name P.O Box 981706
El Paso, TX 79998
19
C-HS MARKETS IPA / Independent Entity (if applicable)
Claims Mailing Address
Alabama (Southern Mississippi) (SMS)
Hattiesburg IPA Lighthouse IPA
Please Insert IPA Name P.O Box 981706
El Paso, TX 79998
Alabama (Georgia) (Atlanta)
CAAP Health Network IPA CAAP Health Network IPA P.O Box 981706
El Paso, TX 79998
Georgia N/A Cigna-HealthSpring P.O Box 981706
El Paso, TX 79998
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. Use and distribution limited solely to authorized personnel. © 2016 Cigna
C-HS MARKETS
IPA / Independent Entity (if applicable)
Claims Mailing Address
Illinois Swedish Covenant Managed Care
SCMCA 2740 W. Foster Ave.,
Ste 409 Chicago, IL 60625
Illinois
University of Chicago University of Chicago c/o MPAS
P.O. Box 3358 Glen Ellyn, IL 60138
Missouri (Kansas City) N/A Cigna-HealthSpring P.O Box 981706
El Paso, TX 79998
Mid-Atlantic
DC Qual-Care IPA Trendsetter IPA
Please Insert IPA Name P.O Box 981706
El Paso, TX 79998
Mid-Atlantic
N/A Cigna-HealthSpring P.O Box 981706
El Paso, TX 79998
20 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna
C-HS MARKETS
IPA / Independent Entity (if applicable)
Claims Mailing Address
Mid-Atlantic (Pennsylvania)
Ben Franklin Physicians IPA Broad Spectrum IPA Delco Wellness IPA
Liberty Independent Physicians Group
Prestige Physician Group
Please Insert IPA Name P.O Box 981706
El Paso, TX 79998
Mid-Atlantic (Pennsylvania)
N/A Cigna-HealthSpring P.O Box 981706
El Paso, TX 79998
North Carolina N/A Cigna-HealthSpring P.O Box 981706
El Paso, TX 79998
South Carolina N/A Cigna-HealthSpring P.O Box 981706
El Paso, TX 79998
Tennessee Synergy HealthCare, LLC Clarksville Medical Network
East Memphis Medical Network HCA - TriStar Medical Network
KMG Memphis Midtown IPA
Please Insert IPA Name P.O Box 981706
El Paso, TX 79998
21 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna
22 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna
C-HS Markets
IPA / Independent Entity (if applicable)
Claims Mailing Address
Tennessee
North Tennessee Medical Network
Premier IPA Rutherford County
Scenic City IPA
Please Insert IPA Name P.O Box 981706
El Paso, TX 79998
Tennessee N/A
Cigna-HealthSpring P.O Box 981706
El Paso, TX 79998
23 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna
C-HS Markets
IPA / Independent Entity (if applicable)
Claims Mailing Address
Tennessee
North Tennessee Medical Network
Premier IPA Rutherford County
Scenic City IPA
Please Insert IPA Name P.O Box 981706
El Paso, TX 79998
Tennessee N/A
Cigna-HealthSpring P.O Box 981706
El Paso, TX 79998
C-HS Markets
IPA / Independent Entity (if applicable)
Claims Mailing Address
Texas N/A Cigna-HealthSpring
P.O Box 981706 El Paso, TX 79998
Texas El Paso Integral Care (EPIC) El Paso Integral Care
P.O Box 981706 El Paso, TX 79998
Texas Prospect Medical Group Prospect Medical Claims
P.O. Box 11466 Santa Ana, CA 92711-14466
Texas WellMed WellMed Claims P.O. Box 400066
San Antonio, TX 78229
C-HS MARKETS
IPA / Independent Entity (if applicable)
Claims Mailing Address
Texas Renaissance Physician
Organization
Renaissance Physician Organization Attn: Claims
P.O. Box 2888 Houston, TX 77252-2888
Texas Valley Organized Physicians Valley Organized Physicians Claims
P.O Box 981706 El Paso, TX 79998
24 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna
ELECTRONIC DATA INTERCHANGE (EDI) CLAIMS
25 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna
EDI is the most common and preferred method of claims submission by providers. Cigna-HealthSpring has direct connections with the following clearinghouses for submission of EDI claims.
Electronic Data Interchange (EDI)
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All Cigna-HealthSpring providers can use the following clearinghouses:
Clearing Houses: All Markets
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Change Healthcare Availity McKession/Relay
Clearing House & Payer ID: Tennessee, Texas, Alabama, Illinois
28
• The following clearing houses and payer ID can be used for the TN, TX, AL, IL markets.
Clearing House Payer ID
Change Healthcare
63092
SSI Group 63092
Proxymed (Caprio) 63092
OfficeAlly 63092
Availity 63092
Relay CPID2795 (Professional Claims)
CPID1556 (Institutional Claims)
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna
Clearing House & Payer ID: Georgia, South Carolina, North Carolina and Missouri
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• The following clearing houses and payer ID can be used for the GA, SC, NC and MO markets.
Clearing House Payer ID
Change Healthcare
52192
SSI Group 63092
Proxymed (Caprio) 63092
OfficeAlly 63092
Availity 63092
Relay CPID2795 (Professional Claims)
CPID1556 (Institutional Claims)
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna
Clearing Houses: Mid-Atlantic and Pennsylvania market • The following clearing houses and payer ID can be used for the Mid – Atlantic and Pennsylvania markets.
30
Clearing House Payer ID
Change Healthcare 52192
Availity 63092
Relay CPID 3839 (Professional) CPID 1978 (Institutional)
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna
Renaissance PHYSICIAN ORGANIZATION (RPO):
31 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2013 Cigna
• Renaissance EDI claim can be submitted using the following clearing houses and payer ID’s:
Clearing House Payer ID
Availity
THS01, HER01
Change Healthcare
33104 (Texas HealthSpring) (HealthSpring Life & Health Insurance Company)
Change Healthcare
76066 (Renaissance Physicians Organization)
HS CONNECT
32 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna
HSConnect Portal allows participating providers access to the information and tools needed to make their interaction with Cigna-HealthSpring more efficient such as verification of customer’s provider network in order to determine claim submission addresses and vendors.
HSConnect
33 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna
• In HSConnect providers can determine where to submit the claims based on the Customer Region.
• The “Customer Region” displays the network a customer is in, which can assist in
determining claims submission.
HSConnect
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INTERACTIVE VOICE RESPONSE (IVR)
35 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna
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 Health
Interactive Voice Response (IVR)
36 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna
When calling the IVR, providers can check a customer’s provider network to determine claim 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 Customer ID Card.
IVR – Claim Submission
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PROVIDER SERVICE CALL CENTER
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Cigna-HealthSpring’s Provider Call Center 1-800-230-6138 can perform the following functions:
• Verify Benefits
• Claims status
• Claim Submissions
• Customer Eligibility
• Check Tracers
• Low service time
The provider customer service call center is available Monday through Friday from 7:00 a.m. to 6:00 p.m. CST.
Provider Call Center
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IMPACT TO CUSTOMERS, PROVIDERS, AND CIGNA-HEALTHSPRING
40 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna
Inappropriate submission of claims will impact Cigna-HealthSpring customers in many ways. Below are a few examples:
• Bills
• Customer’s may receive a bill from a provider who has not received payment for a claim that was misdirected to Cigna-HealthSpring’s claim department instead of the network (FDR) responsible for claims processing and payment.
• Letters & Calls
• Cigna-HealthSpring customers may also receive letters from providers asking them to contact the health plan because they have not received payment.
Impact on Customers
41 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna
Inappropriate submission of claims can also have an impact on Cigna- HealthSpring providers. Here is a key example of this:
• Delay of Payment
• When a claim is misdirected to Cigna-HealthSpring it may cause a delay in the timely processing of the claim.
• A delay in processing the claim timely can then result in the delay of payment to our providers.
Impact on Providers
42 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna
Cigna-HealthSpring customers and providers are the key to our health plan’s success. Misdirected claims causes an adverse impact on both customers and providers. We strive for customer and provider centricity every day.
• Customer Disenrollment:
• As a result of receiving bills, calls and letters from providers who have not received payment for a service, customers may request to disenroll from Cigna-HealthSpring.
• Provider Relationship:
• Providers who do not receive timely payment as a result of misdirected claims may become frustrated and may elect not to renew their contract with C-HS.
Impact on Cigna-HealthSpring
43 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna
All 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 subsidiaries of 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.
Thank you for your participation in the Cigna-HealthSpring Medicare Advantage network