CIGNA Problems? Notify TMA

Physicians having problems with CIGNA's new national imaging arrangement with MedSolutions are asked to notify Genevieve Davis or Erin Smith in TMA's Payment Advocacy Department.

CIGNA hired MedSolutions to arrange the provision of MRI, CT, and PET scans for patients in CIGNA-administered plans. CIGNA encourages radiologists in non-hospital-based facilities to participate in the MedSolutions network. Hospitals and other health care professionals providing radiology services will remain directly contracted with CIGNA.

A statement from the insurer says MedSolutions will be responsible for preauthorization, based on evidence-based guidelines. "These guidelines are in compliance with CIGNA's clinical rules to help ensure that patients receive the most appropriate test the first time around, and improve patient safety by limiting unnecessary exposure to harmful radiation attendant to CT," it said.

CIGNA added that MedSolutions will administer Informed Choice, CIGNA's patient education program, created to educate patients undergoing an MRI, CT, or PET scan about their options for geographically convenient and cost-effective participating facilities.

CIGNA says that after a physician contacts MedSolutions for precertification of coverage of an MRI, CT, or PET Scan, an Informed Choice representative may call the patient and give him or her information about conveniently located and credentialed participating facilities and to offer appointment options. Informed Choice representatives also can provide cost comparison information, so that individuals are aware of the financial consequences of their choice of facility.

In addition, CIGNA says MedSolutions will review and manage nuclear cardiology services. Since July 1, all nonemergency outpatient cardiac nuclear studies must be precertified "and it is the responsibility of the referring in-network health professional to obtain this precertification. MedSolutions will be responsible for prior-authorizing coverage based upon evidence-based guidelines."

Action, Sept. 1, 2011