Pharmacy Management and Credentialing

Pharmacy Management and Credentialing

All the information you need to properly process prescription claims with Cigna.

Cigna Commercial pharmacy plans are in transition to adjudicate on the Express Scripts system in a phased approach. Most Cigna clients will transition on their benefit plan renewal date on or after February 1, 2020.

As of January 1, 2020 all Cigna HealthSpring Medicare claims are adjudicating on the Express Scripts platform.

BIN and PCN Codes

Commercial claims will continue to process utilizing the old BIN/PCN noted below until the group is transitioned to the Express Scripts system. Group numbers that have been transitioned can be found on the Pharmacy Resource Center.

If Commercial claims are submitted for groups that have transitioned with the old BIN or PCN, claims will reject with NCPDP Reject Code 01 (M/I BIN) and 04 (M/I Processor Control Number) with additional messaging providing the new BIN/PCN.

Please do not turn the customer away if you receive a rejected claim. Have them call the phone number on the back of their Cigna ID card. When applicable, the Pharmacy Providers should update impacted members' profiles with the new processing information.

NameNew BINNew PCN (Transitioned Group)Payer SheetsOld BINOld PCN
Cigna Pharmacy Services (Commercial) Ø17Ø1Ø 0215COMM Payer Sheet 02150000 Ø17Ø1Ø Ø215ØØØØ
Cigna International Ø17Ø1Ø 0216INTL Payer Sheet 02160000 Ø17Ø1Ø Ø216ØØØØ
GWH Cigna Commercial Ø17Ø1Ø 0518GWH Payer Sheet 05180000 Ø17Ø1Ø Ø518ØØØØ
Cigna Payer Solutions Ø17Ø1Ø 0519PAYR Payer Sheet 05190000 Ø17Ø1Ø Ø519ØØØØ

Beginning on 1/1/2020, all Cigna HealthSpring Medicare claims will adjudicate on Express Scripts platform.

NameNew BINNew PCNNew RxGroup #Old BINOld PCNOld RxGroup #
Cigna HealthSpring® Medicare Prescription Drug Plans (PDP) Ø17Ø1Ø CIMCARE CIGPDPRX Ø17Ø1Ø CIHSCARE Not applicable
Cigna HealthSpring® Medicare Advantage Plan (MAPD) Ø17Ø1Ø CIMCARE CGMAPDRX Ø17Ø1Ø CIHSCARE Not applicable
Cigna HealthSpring® Medicare Employer Group Waiver Plan (EGWP) Ø17Ø1Ø CIMCARE Please see Member ID Card Ø17Ø1Ø CIHSCARE Not applicable
Leon Cares HMO® (MAPD) Ø17Ø1Ø CIMCARE CGLEONRX Ø17Ø1Ø CIHSCARE Not applicable
Cigna HealthSpring® Arizona HMO (MAPD) Ø17Ø1Ø CIMCARE CIGNAZRX Ø17Ø1Ø CIHSCARE Not applicable
Cigna-HealthSpring® Texas Medicare-Medicaid Plan (TXMMP) Ø17Ø1Ø CIMCARE CGMAPDRX Ø17Ø1Ø CIHSCARE Not applicable
Cigna-HealthSpring® Medicaid Ø17Ø1Ø CIMCAID ZR3A Ø17Ø1Ø CIHSCAID Not applicable

Once transitioned, claim submissions will utilize the Express Scripts networks. Visit the Pharmacist Resource Center.

For copies of Express Scripts payer sheets and provider manuals, or to download Authorization Form 835, visit our Pharmacy Resources.

Pharmacies wishing to join our pharmacy networks, make demographic changes, request835 electronic remits, and more, please visit our Pharmacy Resources or ESIprovider.com for more information.