 New Tools for CIGNA plans
At CIGNA, we are creating tools to help provide greater visibility into cost, quality and simplified payment processes. We have developed several new capabilities that can make it easier for you to determine the amount owed by your patients covered by CIGNA health plans, as well as help determine payment options.
As participation increases in our plans with coinsurance and deductible elements, including CIGNA Choice Fund®, we continually strive to make it easier for you to determine what individuals covered by these plans may owe for your services, and help facilitate payment discussions with them. Many individuals covered by a CIGNA Choice Fund plan have Automatic Claim Forwarding (ACF) enabled so the amount they owe is paid directly out of their health care spending account(s). After claim processing, if funds are available, CIGNA automatically sends payment to you on behalf of the individual with CIGNA Choice Fund coverage, usually along with CIGNA’s portion of the payment. ACF is currently active for over 85 percent of our Choice Fund membership. ACF offers significant bad debt mitigation through automatic and direct payments of the covered individual’s portion of the bill, while helping to lower administrative costs by limiting the need to bill the covered individual.
Fund Balance Added to EDI 270/271
We have recently added the fund balance of a covered individuals’ CIGNA Choice Fund Health Reimbursement Account (HRA) to the outgoing response of the electronic Eligibility & Benefits (E&B) verification (also referred to as the EDI 270/271). This allows you to see if there is a fund associated with that covered individual’s deductible, and if funds are available in their HRA to cover the amount they owe. If the individual has funds available, and ACF is enabled, you will automatically be paid directly by CIGNA. Health Savings Account (HSA) and Medical Flexible Spending Account (FSA) balances will not be added to the 270/271; however, later this year, limited balance information for these accounts will be available through the CIGNA Cost of Care Estimator.
Cost of Care Estimator
In spring 2009, we will nationally release the CIGNA Cost of Care Estimator. The CIGNA Cost of Care Estimator can allow both you and your patients with CIGNA coverage to know the total cost to be charged for medical services based on the covered individual’s specific CIGNA health plan. The Estimator’s real-time treatment cost estimates detail portions of the bill to be paid by the individual’s CIGNA health plan, by the individual’s HRA or HSA, and out-of-pocket, if necessary. You can quickly obtain estimates using your existing desktop technology, so you do not need to invest in new technologies to use the Estimator tool.
Unlike other “real-time adjudication” payment systems, the CIGNA Cost of Care Estimator informs the covered individual and health care professional of the estimated cost of services and how much may be owed prior to services being delivered. The itemized cost estimate is generated by Thomson Reuter’s proprietary treatment cost calculation tool and can be printed as an easy-to-read “Explanation of Estimate” to be shared with patients to aid in financial discussions. The Estimator will be available to registered users of the CIGNA for Health Care Professionals website (www.cignaforhcp.com), and we are currently working with other systems to integrate it into their current Eligibility & Benefits functionality. The Estimator can be used for all covered individuals in our PPO and OAP plans, including Choice Fund, and will be available to physicians, hospitals and facilities.
The CIGNA Cost of Care Estimator will be an important tool that can assist in minimizing confusion, late payments of medical bills and potential bad debt issues. Using the CIGNA Cost of Care Estimator can be beneficial as it provides estimates for many types of medical services, interacts easily and effectively with current systems and serves as a basis of pre-care financial discussion to help avoid after-the-fact collection issues.
We hope these new capabilities help you and your patients covered by CIGNA plans better understand amounts that are owed and the options available for payment. 
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