Posted in Cinga Insurance, Training, Updates

Cigna: Smoking Cessation is covered-Commercial plans

Recently, Cigna began to implement clinical quality Initials that align with NCQA Medical Assistance and Smoking and Tobacco Use Cessation Quality Measure.

As per ACA, smoking cessation is a covered service. Cigna is encouraging the providers to identify, screen and treat for tobacco dependence.

After the Provider will identify the patient, Cigna will reach out to the patient, and encourage them to quit smoking and seek support from their provider.

Which codes to use?

As per Cigna Preventative Care Services Policy: (A004)– these codes can be used with any DX code.

Note: although, Cigna states that these services are covered free of charge to the patient, if the provider performs these services on the same DOS with Preventative EM code then some of these tobacco cessation treatment services could be subject to additional out of pocket costs for your patients. To avoid this, providers are allowed to bill the smoking cessation codes on a separate encounter as preventative services (EM codes).

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Posted in Cinga Insurance, Training, Updates

Cigna: RAMICADE Reimbursement Policy Change

Are you a provider that administers RAMICADE for Cigna patients? Then this blog post is for you!

As of July 2021 Cigna removed RAMICADE from its preferred medications list. This change will apply to Cigna Commercial Plans.

This change will Apply to Individual and Family Plans on January 1,2022 and thereafter.  

What providers should do?

IF you are a provider that currently accepts CIGNA Commercial plan patients in your office, CIGNA encourages you to work with your Cigna Patients to switch to either AVSOLA or INFLECTRA.

Do I need a new authorization starting 07/01/2021?

No. Providers are allowed to administer either AVSOLA or INFLECTRA without any further action: provided that the patient meets medical necessity and there is no change in dosing, frequency or site of services.

What is the Authorization time frame for AVSOLA and INFLECTRA?

July 1, 2021 to May 1, 2022.

How can a provider obtain a copy of the authorization?

Please call 1800-882-4462 Cigna Coverage Review Department, to request a letter of authorization.

What if I RAMICADE is medically necessary for my patients?

If provider believes that a non-preferred medication is medically necessary for the patient, provider can contact Cigna Coverage Review Department and request a medical necessity review. Provider can also request medical review through CovermyMeds or Surescripts.

Who can I contact for additional information?

Please contact Accredo: 1866-759-1557 or CuraScript SD 1877-599-7748 or any other participating specialty pharmacy.

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