HNS Policy 

If referring Cigna and/or Great West HealthCare members to a DME vendor, HNS providers must refer members only to the approved Cigna/GWH DME vendor

 

 

 DME - ORTHOTICS

Please remember that Cigna/Great West HealthCare will only reimburse network providers for chiropractic services that are listed on the Cigna HealthCare fee schedule and only if those services are covered under the member's specific plan.

 

NOTE:  HNS network providers may not bill Cigna for any DME. 

 

If you have a Cigna patient that needs orthotics, and orthotics are covered under the member's plan, these patients must be referred to Cigna HealthCare's authorized DME orthotic vendor.  

 

 

If DME is covered by Cigna: 

  • If you have a Cigna patient that needs DME and the DME is a covered benefit under the member's plan, these patients must be referred to Cigna HealthCare's authorized DME orthotic vendor.

  • When DME is covered under no circumstance may the provider bill the patient directly.

 

If DME is NOT covered by Cigna:

  • If the DME is not covered, you must have evidence of this in the member's health care record via a completed Verification of Benefits Form. This form must include all relevant information, including the name of the member, the date of the call, the name of the Cigna representative that verified the benefit(s), a reference number, and the specific codes/services verified.

  • You must obtain a signed waiver from the member prior to providing services, attesting to the member's agreement to receive and pay for the specific DME recommended.

  • Both the waiver and the verification of benefits form must be maintained in the patient's healthcare record.

 

ONLY if you have obtained the information outlined above may providers bill the member directly for the DME.

 

Cigna HealthCare requires that all orthotics be referred to the authorized Cigna vendor, Linkia. Linkia, a specialty health care company, is dedicated to serving the orthotics industry and working to provide the best possible interface between payors and providers.

 

Please follow the instructions below when referring a patient to Linkia for orthotics:  

  1. While your patient is in your office, please ask them to choose one of the authorized Linkia locations that is most convenient for them to visit. All Linkia locations for both North and South Carolina can be obtained from this list CLICK HERE.

  2. Once your patient has chosen a location, complete the Orthotic Referral Form.

  3. Fax the completed form and a copy of the patient ID card to Linkia Provider Services. Fax number: (877) 254-6542.

  4. Make two copies of the completed form. One copy must be kept in the patient health record. The other copy must be given to the patient to take with them to the authorized Linkia Dealer. 

  5. A Linkia Provider Services representative will contact the Linkia authorized site. Once the authorized site has confirmed acceptance of the referral, the Linkia representative will contact your office stating the referral has been accepted. 

  6. After you receive approval of the Linkia site, you will need to contact your patient and ask that they call the site to make an appointment. The site information will have been given to them on their copy of the Linkia Referral Form.
     

  7. Once your patient has been approved to visit the Linkia office, all orthotic visits will be between the Linkia approved site and the patient.

 

To obtain a current list of referral options, please contact Linkia Provider Services at 1-877-754-6542, option 1.  If the patient has any questions about their specific plan coverage; they must call Cigna (see back of ID card for contact information).

 

For more information on Linkia's services and referrals, please visit their web site www.linkia.com.

 

 

  

 DME (other than Orthotics)

Please remember that Cigna HealthCare will only reimburse network providers for chiropractic services that are listed on the Cigna HealthCare fee schedule, and then only if those services are covered under the member's specific plan.

 

NOTE:  HNS network providers may not bill Cigna for any DME.

 

 

If DME is covered by Cigna: 

  • If you have a Cigna/Great West patient that needs DME and the DME is a covered benefit under the member's plan, these patients must be referred to Cigna HealthCare's authorized DME vendor.

  • When DME is covered, HNS providers cannot bill the patient directly.

 

If DME is NOT covered by Cigna:

  • If the DME is not covered, you must have evidence of this in the member's health care record via a completed Verification of Benefits Form. This form must include all relevant information, including the name of the member, the date of the call, the name of the Cigna representative that verified the benefit(s), a reference number, and the specific codes/services verified.
     

  • You must obtain a signed waiver from the member prior to providing services attesting to the member's agreement to receive and pay for the specific DME recommended.

  • Both the waiver and the verification of benefits form must be maintained in the patient's health care record.

 

ONLY if you have obtained the information outlined above may providers bill the member directly for the DME.

 

 

If your patient needs DME, other than orthotics, please follow these steps:

  1. Call CareCentrix at (888) 999-2422. When you call, please choose option 1 "new referral". You will need to fax the DME prescription and patient demographics including name, address, DOB, insurance plan name, subscriber ID number, etc. You will also need to provide the address where the DME will be shipped.

  2. Once CareCentrix receives the demographic and other information, they will determine the most convenient and appropriate Cigna DME vendor for your patient and will ship the DME to the patient. 

 

 

If you and/or the patient have any questions about the specific plan coverage of the DME, please call Cigna HealthCare at (800) 88-Cigna.