tracelogoRBReference Guide for CIGNA Commercial Plans

 

(Covers both CIGNA and "Health Partners" plans)

 

The CIGNA Commercial Reference Guide provides information specific to CIGNA commercial plans which includes plans whose member ID cards state  "CIGNA" or state "Health Partners".  This Guide excludes information related to the CIGNA Connect and SureFit Plans.  For information on those plans, please see the applicable Reference Guide.  The information in this section is in addition to the HNS/Payor Policies. 

 

NOTE:  For contracted health care providers, Cigna only covers those chiropractic services listed on the Cigna fee schedule, regardless of information you may receive when verifying benefits.  Because of this, only codes listed on the CIGNA fee schedule should be submitted to HNS.

 

Please note: if the member has secondary insurance which covers a service not listed on the fee schedule, please submit the primary claim to HNS via a paper CMS 1500 claim form, and the claim will be forwarded to CIGNA.

 

As with all plans, coverage is subject to member eligibility, plan limitations and timely filing requirements. 

 

Cigna Corporate Medical Policy for Chiropractic takes precedence over any information you receive from Cigna telephone representatives. 

 

Please contact your HNS Service Representative to determine if a particular service is consistent with Cigna.  Click here for the Cigna and GWH-Cigna HealthCare Corporate Medical Policy for Chiropractic.

 

The Cigna HealthCare Quick Reference Guide contains the following information specific to Cigna HealthCare and provides you with helpful information regarding your Cigna HealthCare patients.

 

 

General Information

 

Eligibility/Benefits

 

Referral System

 

Cigna ID Cards

 

Claims Submission

 

Claims Inquiries

 

Provider Relations 

 


 

 

General Information 

 

Please ignore the claims billing address on the member ID card or any address given to you on the telephone when verifying eligibility and benefits. If Cigna claims are inadvertently sent directly to Cigna rather than to HNS, your claims will be processed at 'out-of-network' benefits, so please remember to send all Cigna claims to HNS.

 

Our instructions for filing claims supersede information given to you by Cigna HealthCare Representatives.

  

With only a few exceptions, all claims for COVERED SERVICES provided to a beneficiary of a HNS contracted payor MUST be submitted to HNS. 

 

 

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Eligibility/Benefit 

 

To verify eligibility and/or benefits for Cigna members, please visit their website for HealthCare Professionals, www.Cignaforhcp.com or call 1.800.88Cigna (882-4462). 

 

To verify eligibility and/or benefits for GWH-Cigna members, please visit their website at www.GWHCIGNAforhcp.com or call (888) 663-8081.

 

If you do not already have a username and password, please contact your HNS Service Representative and we will gladly assist you. 

 

CLICK HERE  for the HNS Verification of Benefits Form.

 

  • See the member ID card for the correct number to call to verify eligibility and benefits. (Chiropractic benefits vary by plan and most plans have benefit and/or visit limitations.)
  • For Cigna HealthCare members, you may also call (800) 88-Cigna.

 

NOTE:  When asked for your Federal Tax ID number (EIN), you must give the HNS Federal Tax ID (56-1971088). Cigna has all HNS participating providers listed under the HNS Federal Tax ID number.

 

  • Cigna HealthCare also leases their provider network to Third Party Administrators.  For Cigna TPAs, please refer to the back of the member's ID card for telephone numbers or you may use the phone numbers listed below:

    Boiler Makers   (866) 342-6555
    MVP   (888) 687-6277
    MVP Kodak   (800) 999-3920
    MVP Preferred Care   (888) 581-8030
    Health Partners   (800) 444-4558
    APWU   (800) 222-2798
    Samba   (800) 638-6589
    NALC   (888) 636-6252
    Starbridge Select   (800) 308-5948
    Aftra   (800) 562-4690
    FDA (JCP)   (866) 337-8417
    American Maritime Officers   (800) 348-6515
    Plumbers & Pipefitters   (800) 842-5899
    Seafarers Health & Benefit Plan   (800) 252-4674
    Sheet Metal Workers   (615) 859-0131
    Tufts Health Plan   (888) 884-2404

     

  • You may also verify eligibility and benefits on the Cigna for HealthCare Professionals website, www.Cignaforhcp.com.  If you do not already have a username and password, please contact your HNS Service Representative and we will gladly assist you.

 

 

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Referral System

 

Most Cigna plans are direct access plans, and referrals from PCPs or prior authorization are not normally necessary.  However, there may be a few self-funded plans that require a referral or prior authorization so always ask when verifying benefits.

 

  • When it is necessary to refer to another health care provider, referrals within the network are required unless there are no participating Cigna providers in the area where the patient is being referred.

     

  • ALL Orthotics must be referred to Linkia, please CLICK HERE for instructions on how to refer a patient to Linkia.

     

    ALL DME purchases must be referred to CareCentrix, please CLICK HERE for instructions.

 

 

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Cigna ID Cards 

 

Primary claims for ALL Cigna and GWH-Cigna plans must be filed to HNS through HNSConnect® with the exception of the Cigna Indemnity plan and some of the Third Party Administrators. 

 

For Cigna claims filed through HNS, please note the following:

  • If the patient needs pre-certification, the pre-certification requirement is shown on the back of the ID card as either "Inpatient Admission" or "Inpatient Admission and Outpatient Procedures."  For chiropractic, if it states "Inpatient Admission and Outpatient Procedures," please make sure when verifying eligibility and benefits that chiropractic does not need pre-certification on ANY services to be rendered on the patient.

     

  • The "Away from Home" logo indicates member has access to the Cigna National Network.

     

  • ID cards with the Cigna Care Network logo indicate the member liability varies based on the provider's Cigna Care Network designation.

 

NOTE:  Cigna CARE PLAN - Because chiropractic is not currently one of the specialties included in the "Cigna CARE NETWORK", HNS providers are not 'in-network' for the Cigna CARE PLAN.

 

  • ID cards for GWH-Cigna will display “GWH-Cigna” in the upper right hand corner of the card.

 

If you are uncertain about where to file the claim, please email your HNS Service Representative a clear, legible copy of the member ID card and we will respond back to you with an answer within 24 hours.

 

 

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Claims Submission 

 

All primary claims for Cigna HealthCare and GWH-Cigna must be submitted to HNS through the HNSConnect®  system. 

 

Exceptions:  Secondary claims, corrected claims, claims with attachments, and some of the Third Party Administration (TPA) claims.  Some Cigna TPA claims come to HNS electronically and some must be mailed to us on paper CMS 1500 claim forms.  Please see below to identify which Cigna TPA claims are submitted to HNS by mail (on CMS 1500 claim forms).

 

 

Paper Claims for GWH-Cigna: 

All primary claims must be filed to HNS within 30 days from the date of service.

 

GWH-Cigna paper claims submitted to HNS must be accompanied by a copy of the GWH-Cigna ID card. 

 

CLICK HERE  for information on filing secondary claims.

 

CLICK HERE  for information on filing corrected claims. 

 

Please ignore any instructions regarding where to submit claims by payor phone representatives!  HNS instructions regarding where to submit claims supersede all other instructions given by payor representatives when verifying eligibility and benefits.

 

In order for Cigna HealthCare and GWH-Cigna claims to adjudicate quickly and accurately, please note the following information regarding claims submission specific to Cigna HealthCare. 

  • Group or Policy number must be in box 11 (often called "Account #" on Cigna ID card).

     

  • Claims must be identified in box 11c as "Cigna" or "Great West Healthcare" or "GWH-Cigna", as applicable.

     

  • Box 17, referring provider, must be left blank on all Cigna HealthCare and GWH-Cigna claims.

     

  • All Cigna TPA claims must be submitted electronically through HNSConnect®. 

Exception:  The following Cigna TPA claims must be submitted to HNS on CMS 1500 claim forms and mailed to the HNS address.  The name of the TPA must be on the claim form in box 11c. 

    • MVP

       

    • MVP Kodak

       

    • MVP Preferred Care

       

    • Health Partners

       

    • Starbridge Select (Cigna network will be listed on the ID card)

       

    • FDA (JCP)

       

    • Sheet Metal Workers

       

    • Tufts Health Plan

 

  • When filing Great West or traditional claims electronically, the claim must be identified as a Cigna claim in the address section at the top of the form using the example address below:  

EXAMPLE:  HNS-Cigna

PO Box 2368

Cornelius, NC  28031

 

 

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Claims Inquiries

 

For tracing Cigna claims: 

You may check the status of your claims using the Cigna for HealthCare Professionals website, www.Cignaforhcp.com.

 

For tracing GWH-Cigna claims: 

  1. You may check the status of your claims using the GWH-Cigna website, www.gwhCignaforhcp.com.
  2. For tracing outstanding claims (after 60 days from your billing date), please email your HNS Service Rep and include the patient name, date of birth, member ID number, and dates of service in question.  We will gladly trace the claim for you and will respond back to you within three business days.

 

Resubmit lost/missing claims through HNS.

 

Contact your HNS Service Representative if you have any questions relating to the adjudication of your Cigna or GWH-Cigna claims.

 

 

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Provider Relations 

 

Questions relating to your participation in these Cigna products should be directed to your HNS Service Representative at (877) 426-2411.  

 

 

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