Tag: #cigna

Posted in Cinga Insurance, Training, Updates

Cigna: RAMICADE Reimbursement Policy Change

Posted on by KR2Medical Billing

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.

Do you find this content useful? Follow my blog for more medical billing and coding updates. As well as medical coverage/reimbursement policy updates.

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Posted in Cinga Insurance, Updates

Cigna Update: Change to Shoulder Arthroplasty Coverage Review, 06/01/21

Posted on by KR2Medical Billing

The following policy is effective 06/01/2021 and applies to Cigna Fully Insured and Self-Funded Plans.

Background: CMS and an evidence-based guidelines from MCG Health designate shoulder arthroplasty procedures (CPT codes 23470 & 23472) as outpatient, when medically appropriate.

Picture via Mayo Clinic 2014.

Starting 06/01/2021- Cigna may deny CPT 23470 & 23472, when requested for inpatient level of care. (inpatient setting).

eviCore will review the inpatient level of care requests for medical necessity and level of care. eviCore will base its review of medical necessity based on MCG Health criteria.

Denials will include the medical necessity appeal rights.

The above policy is basically the site-of-care policy for Cigna Fully Insured and Self-Funded Plans.

Possible Solution to avoid unnecessary Denials: Make sure you review the Cigna Shoulder Arthroplasty Policy and CIGNA Site-of-Care Policy. Site-of-Care policy will give you the criteria for the patient to qualify for the inpatient setting and receive inpatient level of care as oppose to outpatient setting (ASC).

(Shoulder Arthroplasty Policy is updated for 07/01/2021) Please visit the links above for the FULL CIGNA POLICIES.

Posted in Cinga Insurance, Updates

CIGNA: LocalPlus Plans for 2021 (Multiple States)

Posted on by KR2Medical Billing

Effective 01/01/2021 Cigna LocalPlus Plan will expand into the following markets:

LocalPlus Plans include a full list of services provided by a traditional Cigna-administered plans. However, these benefits are only limited to services that are furnished by local participating providers and facilities.

There are 4 types of LocalPlus Plans: LocalPlus, LocalPlus In-Network, Choice Fund LocalPlus, and Choice Fund LocalPlusIn.

The main difference between LocalPlus Plan and LocalPlusIn is the level of benefits and whether the members have access to local LocalPlus in-network participating providers for covered services.

If your patients have an access to Cigna national Open Access Plus network, they will have a away from home logo, on the back of the card.

Below are sample Cigna LocalPlus cards:

FRONT OF THE CARD
BACK OF THE CARD

Provider TIP: *To avoid costly denials, make sure to verify that you participate in the LOCALPLUS network. *

Suggested workflow: Once the patient contacts your office, to make an appointment, have your staff call the customer services to verify your plan participation. If customer service does not have that information, you might have to contact your Cigna Network Representative and verify with them, if you are a participating provider. Do not assume that because you are in network with your local insurances that you also participate with this plan. (network)