tracelogoRBDME for CIGNA/GWH Patients

 

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.

 

NOTEHNS 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 healthcare 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.

 

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 (882-4462).