POLICY UPDATE

Preventive Care Coverage Update

CIGNA has changed how preventive care claims are administered to better align with our preventive care policy.

Previously, services not included on CIGNA's list of covered preventive services may have been paid at the preventive care benefit level when submitted with a preventive care claim. Now, regardless of whether they are submitted separately or as part of a preventive care claim, services that are not on the list of preventive services will be considered for coverage under the patient’s available non-preventive/routine care benefits, and patient cost-sharing may apply.

CIGNA's list of covered preventive benefits includes all of the United States Preventive Services Task Force (USPSTF) recommendations rated “A” or “B,” including any new items that may not have been previously covered under our preventive care benefit but are now mandated for inclusion by the Patient Protection and Affordable Care Act. See below for examples of services not included in the list of covered preventive care benefits to which patient cost sharing may apply:

 This change does not affect your fee schedule. All that is changing is the coverage category under which these non-preventive care services will be reimbursed. Patient cost-sharing will continue to be explained in the Explanation of Payment (EOP).

Additional services not covered as preventive care may be covered at a different benefit level. Information about eligibility and benefits for your patients with CIGNA coverage is available on the secure CIGNA for Health Care Professionals website, www.cignaforhcp.com > View Member Eligibility and Benefits. For patients with GWH-CIGNA ID cards, visit www.gwhcignaforhcp.com > Eligibility and Benefits Inquiry.  For additional information on preventive care, including the full list of covered preventive services in A Guide to CIGNA's Preventive Health Coverage for Health Care Professionals, visit www.cigna.com/health/provider/medical/care_guidelines.html.

Featured Article

• Cultural Competency - Increase Quality of Care and Improve Patient Compliance

Policy Updates

• Clinical, Reimbursement and Administrative Policy Updates
• Evaluation and Management Coding Review
• Preventive Care Coverage Update

Electronic Tools

• New eCourse Available
• Receive Your CIGNA Remittance Reports Online
• Transparent Cost of Care

Pharmacy Updates

• CIGNA Pharmacy Step Therapy Program to Expand
• New Value Prescription Drug List Option

Integration Updates

• Network Differences
• Ancillary Vendor and Facility Referrals
• Claim and Service Channels
• Brand Changes
• Revised GWH-CIGNA ID Cards
• Updates to the Secured Provider Portal
• Secure Websites

General Updates

• Eligibility and Benefit Enhancements
• New CIGNA Paper Claim and Correspondence Addresses and Fax Numbers
• Urgent Care for Non-emergencies

Helpful Reminders

• Reference Guides Updated
• Tell Us What’s Changed
• Use the Network
• Tools for Improving Claim Processing
• Access the Archives
• Go Green - Go Electronic