Industry News: Cigna

As we look to standardize processes and procedures across all CIGNA business, we will adopt a common time frame for health care professionals to follow for submitting claims to CIGNA. Except where state law requires a longer time frame, the claim filing limit will change from 180 days to 90 days for participating health care professionals.

The National Correct Coding Initiative (NCCI) consists of codes that have paired edits. When the two codes are billed together the edits are in place to prevent improper payment for claims submitted together for Part B services. CMS has developed NCCI edits-physicians, NCCI edits-outpatient, and Medically Unlikely Edits (MUE) to help protect the Medicare Trust Fund.

Have you recently changed addresses, specialties, phone numbers, tax identification numbers or have doctors left your group? It is important to notify CIGNA of these changes. Demographic information is used to process claims, send you communications and is published in the CIGNA provider directories.

Submit changes electronically using the online form available on the CIGNA for Health Care Professionals website at www.cignaforhcp.com and on the Secured Provider Portal at www.gwhcignaforhcp.com.

For more information, call:

1.800.88CIGNA (882.4462) for CIGNA changes.

Beginning in November 2010, CIGNA will begin a gradual transition from widespread use of Connecticut General Life Insurance Company (CGLIC) to the use of a new legal entity to underwrite certain types of contracts and documents. The new legal entity, CIGNA Health and Life Insurance Company (CHLIC), will become another important legal underwriting entity over time.

Medicare requires that medical record entries for services provided/ordered be authenticated by the author. The method used shall be a hand written or an electronic signature. Stamp signatures are not acceptable. Patient identification, date of service, and provider of the service should be clearly identified on the submitted documentation. (Medicare Internet Only Manual 100-8, Ch 3, sect 3.4.1.1(b))

Recently many claims and supporting documentation have been submitted containing unlisted CPT® code(s) for which a separate, payable procedure cannot be identified. When this occurs, the unlisted CPT® code is denied.

Recently CIGNA Government Services has noticed an increase in the number of insufficient documentation and medical necessity errors received as a result of CERT claim reviews.

This increase in the number of insufficient documentation and medically unnecessary claims seems to correlate with the regulations in the Medicare Benefit Policy Manual, Chapter 15, Section 80.6.1.

March 30, 2009 CMS issued the following Joint Signature Memorandum (JSM) (JSM/TDL-09225, 03-26-09):

Recently the Department of Health and Human Services' Office of Inspector General (OIG) conducted an evaluation of the Comprehensive Error Rate Testing (CERT) Review Contractor. As a result of this OIG review, we have concluded that the provision in the Program Integrity Manual (PIM) that has come to be known as the "clinical review judgment" provision is confusing and contradicts itself in parts.