Cigna Expands Precertification List — Payer Newsletter Excerpt

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Cigna has added to its precertification list 67 newly released CPT codes, and 29 Centers for Medicare & Medicaid Services HCPCS codes. Twelve are from new CPT code sets for multianalyte assays with algorithmic analyses and proprietary laboratory analyses. Deleted from the list were two codes for digital breast tomosynthesis: 77061 (unilateral) and 77062 (bilateral).

To view the complete precertification list, log in to CignaforHCP.com and click on “Precertification Policies” under Useful Links. 

Also new for 2018 …   

  • Cigna has created a new coverage policy on vitamin D testing, effective March 15, and will pay claims billed with CPT code 82306 or 82652 only when medically necessary for people younger than 18, older than 65, and pregnant women. Previously, Cigna paid claims for vitamin D testing for all diagnoses (wellness and nonwellness) without such a review. Also, payment for modifier 78 fell from 84 percent to 70 percent, effective Feb. 19. Modifier 78 is used to bill for a postoperative unplanned return to the operating or procedure room by the same physician for a procedure related to the initial one. See additional medical policy updates with effective dates in February, March, and April in the January edition of Cigna’s Network News.  
  • Cigna has expanded its utilization management program, making more drugs subject to prior authorization, step therapy, or quantity limits. If needed, you can search for alternative drugs using a patient-specific drug coverage search tool at CignaforHCP.com (log in, then search by patient name, ID number, or date of birth). Also, see Cigna’s prescription drug list changes that went into effect Jan. 1. This list highlights the covered, preferred brand-name, and generic drug changes within all affected classes.
  • For your patients with GWH-Cigna or “G” ID cards, electronic funds transfer scheduled claim payments increased from once per week to three times per week, according to this payment calendar. The change took effect the week of Feb. 19.  

New when you log in to CignaforHCP.com

Cigna’s provider website has new features you may find useful:  

  • Better way to submit pended claim documentation (go to “Claims inquiry,” then “Claim detail”). Instead of mailing or faxing supporting documentation for existing claims, now you can upload and send it in electronically. When you have a pended claim, Cigna will notify you through existing channels, such as fax or mail. Regardless of how you submitted the original claim, you then can log in to view the claim and the related pend reason code.
  • More information on Patient and Plan Detail pages (click “Patient,” conduct a patient search, then click on the patient ID). Now you can see:
  • If your patient has a health reimbursement account, health savings account, or flexible spending account;
  • More of the health and wellness programs available for the patient; and
  • If the patient’s plan requires a referral, with a direct link to the provider directory.   

Accountable care for beginners

Cigna has introduced a collaborative accountable care (CAC) program that is “administratively less resource-intensive” than its traditional CAC program. The new Cigna CAC Focus program focuses on fewer quality and efficiency measures, and requires fewer patients with Cigna-administered coverage to be aligned with these measures than in the traditional program. Physicians and providers new to value-based payment or who want a more streamlined population health model — and have at least 1,500 aligned primary care patients — may qualify for this program. For information, call Cigna Customer Service at 800-88Cigna (882-4462).

Existing physician profiles will display through 2018

Cigna is extending the time frame for existing Cigna Care designations, quality symbols, and cost-efficiency stars to display in its online provider directories. These profiles will remain in effect through the end of 2018. If you have questions about your profile status, including reconsideration requests, email them to PhysicianEvaluationInformationRequest[at]Cigna[dot]com.

(Source: Cigna Network News, January 2018.)

The Texas Medical Association’s payment specialists continuously review health care payment plans’ newsletters and updates for items important to Texas physicians. Texas Medicine Today periodically publishes key excerpts from those newsletters that you might have missed.

If you have questions about billing and coding or payer policies, contact the specialists at paymentadvocacy[at]texmed[dot]org for help, or call the TMA Knowledge Center at (800) 880-7955. Members can use the TMA Hassle Factor Log to help resolve insurance-related problems. Visit www.texmed.org/GetPaid for more resources and information.


Last Updated On

March 28, 2018

Originally Published On

March 28, 2018

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