 cigna quick reference guide for chiropractic
NOTE: CIGNA HEALTHCARE Corporate Medical Policy for Chiropractic takes precedence over any information you receive from Cigna telephone representatives for Cigna members. Always contact your CNC Provider Rep to determine if a particular service is consistent with Cigna corporate medical policy.
Cigna Quick Reference Guide For Chiropractic
Plans:
HMO, Network, POS, PPO, EPO, HMO Open Access, Network Open Access, POS Open Access,
Open Access Plus, Cigna Choice Fund
PRECERTIFICATION
A few Cigna plans may require preauthorization for certain procedures, such as MRI's.
For preauthorizaton, call MedSolutions: 1 888-693-3211
General Information
PLEASE DO NOT SEND YOUR CIGNA HEALTHCARE CLAIMS TO CIGNA! ALL CIGNA CLAIMS MUST BE SENT DIRECTLY TO CNC!
Ignore the claims billing address on the member ID card or ANY ADDRESS given to you on the telephone when verifying benefits. You are under contract through CNC and our instructions for filing claims override information given to you by Cigna Representatives!
All claims for COVERED SERVICES provided to a beneficiary of a CNC contracted payor MUST be submitted to CNC. Participating providers who fail to submit all such claims to CNC may lose thier status as a Network Provider. (This includes any self-funded groups who utilize a CNC contracted payor as a third party administrator.)
Cigna Healthcare offers many different plans and chiropractic benefits vary based on your member’s plan. Always verify specific chiropractic benefits for each member!
Waiving Co-payments, Deductibles and Coinsurance
It is unlawful to waive co-payments, deductibles, coinsurances, or other patient responsibility
payments and is specifically prohibited by our contracted managed care partners.
This includes accepting a "lower" co-payment amount than the amount indicated on the member's subscriber ID card, waiving co-payments including for services deemed “professional courtesy” and TWIP (take what insurance pays).
Absent true financial hardship (with complete, current, supporting, documented evidence of such hardship maintained in the patient’s health record), the full amount of the co-pay as well as ALL co-payments, deductibles and coinsurance due and owed must be collected by all network providers.
For CNC Contracts:
Failure to consistently comply for individuals covered by a CNC contracted payor is in violation of the policies of our contracted payors and may result in the termination of your status as a CNC participating provider.
For Medicare:
Failure to comply for individuals covered by Medicare is a violation of the Federal False Claims Act,
Federal Anti-Kickback Statute, and the Federal and State Insurance Fraud Laws. Failure to comply may
result in civil money penalties in accordance with the new provision section 1128 A(a)(5) of the Health
Insurance Portability and Accountability Act of 1996 [section 231(h) (HIPAA).
IMPORTANT NOTE:
NEVER SEND A W-9 FORM WITH NEW TAX ID NUMBER (EIN) DIRECTLY TO CIGNA! ANY CHANGE IN YOUR PRACTICE INFORMATION MUST BE SENT DIRECTLY TO CNC. CNC WILL NOTIFY CIGNA OF YOUR CHANGES!
 Benefit/Eligibility
See the member ID card for the correct number to verify benefits and check member eligibility. (Chiropractic benefits vary by plan and some plans may have benefit and/or visit limitations.)
- When calling Cigna, always identify yourself as a participating provider to obtain the correct benefit level. SPECIAL NOTE: When asked for your Federal Tax number (EIN#), you must give the CNC MASTER TAX
ID# 56-1971088 in order to be identified as a participating CNC provider. If you give your own federal tax number, you may be told that you are a non-participating provider. (Cigna has all CNC participating providers listed under the CNC Master Tax ID number.)
Referral System
- Generally speaking, most products are a direct access plan and no referral from a PCP or prior authorization is needed. There may be a few self-funded plans that have special rules and may require a referral or prior authorization so ALWAYS ask when verifying benefits.
- When it is necessary to refer to another health provider, referrals within the network are strongly recommended.
Co-payment/Co-insurance Collection
- No money is collected at the time of service unless there is a co-payment amount stated on the ID card. We recommend that you always ask whether the member’s plan has a co-payment or deductible when verifying benefits.
- Some plans only require a co-payment, while others may have a deductible and co-insurance.
- Upon receipt of the notification of payment or remittance summary, provider may bill for any deductible or co-insurance up to Cigna’s allowed amount.
- Provider may not balance bill for the discount amount.
- Non-covered services may be billed to the member at the provider’s normal charges, if the member was advised in writing, in advance, that the services would be non-covered.
Claims Submission
Submit all claims to:
CNC/Cigna SC
PO Box 2368
Cornelius, NC 28031
IGNORE THE ADDRESS ON THE MEMBER'S ID CARD OR ANY ADDRESS GIVEN TO YOU BY PHONE WHEN VERIFYING BENEFITS AND SEND ALL CIGNA HEALTHCARE CLAIMS DIRECTLY TO CNC.
Please refer to the CNC Billing Instructions for complete information on claims submission. The following information is additional information regarding claims submission specific to this contract.
Claims must be identified in box 11C as “CIGNA”.
Box 11 must contain the group number, which is shown as the "account"
number on the member's ID card.
- The claim must be identified as a Cigna claim in the address section at the top of the HCFA form (CNC/Cigna is an acceptable format). Be sure that you put the CNC address here.)
EXAMPLE:
CNC/Cigna
PO Box 2368
Cornelius, NC 28031
- If filing Cigna as secondary, always attach copy of the primary EOB from the payor, and submit this, together with a new HCFA 1500 direct to CNC.
- Remember to include the 2 digit suffix, such as 01 or 02, etc as part of the
member's ID number in box 1A of the HCFA.
Claims Inquiries
- For tracing overdue claims (after 60 days from your billing date), complete the CNC Fax Form and fax to CNC. We will gladly trace the claim for you. We will fax the results to you within 5 business days from receipt of your fax.
- Resubmit lost/missing claims through CNC.
- If submitting a corrected claim, you must STAPLE the appropriate EOB to the HCFA 1500 and send to CNC. Please mark “corrected” claim on the HCFA 1500.
- For questions relating to payment of a claim, contact the payor at the address shown on the notification of payment.
- Refer to your CNC/Cigna schedule to confirm allowable amounts.
Provider Relations
Questions relating to your participation in these Cigna products should be directed to CNC
at 704-895-8117, EXT. 2.
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