Thanks to the work of the Texas Medical Association and other medical societies involved with the Physicians Advocacy Institute (PAI), physicians may resubmit their previously denied CAD mammography claims to CIGNA. Claims can be resubmitted from June 1 through Dec. 1, 2007.
This opportunity to resubmit claims is another victory resulting from the settlements in the national class-action antiracketeering lawsuits against the nation's for-profit health plans. TMA and PAI used the formal compliance dispute resolution process that was part of the CIGNA settlement agreement to force CIGNA to pay these claims.
Eligible claims must:
- Involve CPT® Codes 76082 or 76082 as add-on codes with 76090, 76091, or 76092, and,
- Have been submitted between Jan. 1, 2004, when the CAD Mammography add-on codes became effective, and Oct. 10, 2004, when CIGNA began paying the claims.
Resubmitting claims is simple. It involves completing the spreadsheet that can be downloaded from the TMA Web site or at www.hmosettlements.com or www.CIGNA.com . Completed spreadsheets should be e-mailed to CADMammoRebsubmit@CIGNA.com . Questions may also be e-mailed to this address.
Physicians without access to e-mail can mail their completed spreadsheets to the CIGNA R&R Department P&C, P.O. Box 9018, Sherman, TX 75091-9018, and can e-mail questions to Connie Foxx in the TMA Payment Advocacy Department, or call her at (800) 880-1300, ext. 1414, or (512) 370-1414, or call the CIGNA Compliance Dispute Facilitator, Deborah Winegard, at (404) 881-8900.
Any physician who believes that Aetna, CIGNA, HealthNet, Humana or Anthem/Wellpoint, are violating the terms of their settlement agreements should contact Ms. Foxx.