Virtual care Services require POS 02
Throughout the pandemic, we recommended that providers bill virtual care services with a face-to-face Place of Service (POS) code to ensure that covered services were reimbursed at face-to-face rates. Over the last two years, we have received meaningful insights from providers who indicated they wanted to be able to bill for virtual care services with POS code 02 instead, which more closely aligns with guidance from the Centers for Medicare & Medicaid Services. 

Accordingly, we recently updated our systems to ensure providers now receive 100 percent of face-to-face reimbursement for covered virtual care services when billed with POS code 02. Therefore, we now recommend providers bill with POS code 02 for all virtual care services. As an added benefit, when you bill with POS code 02, your patients may pay a lower cost share for the virtual services they receive due to a recent change in some plan benefits.

READ MORE 

Planned Medical Policy Updates
To support access to quality, cost-effective care for your patients with a medical plan administered by Cigna, we routinely review clinical, reimbursement, and administrative policies for potential updates. As a reminder, reimbursement, and modifier policies apply to all claims, including those for your patients with “G” ID cards.

• Modifier 26 – Professional Component (M26)
• Unacceptable Principal Diagnosis Codes (R38)
• Nonpharmacological Treatments for Atrial Fibrillation (0469)

READ MORE 

If you have Instamed - Register to Receive Patient Payments
Your patients with Cigna-administered plans can now choose to pay you for their out-of-pocket expenses through myCigna.com, our customer website. We recently integrated the health care bill payment capabilities of InstaMed, a J.P. Morgan company, with myCigna.com to implement this enhanced service. 

Please note: This does not affect payments you receive directly from Cigna.

READ MORE 

Submit Reconsideration and Appeals Request Online
Did you know you can submit claim reconsideration requests and appeals, as well as precertification appeals, on the Cigna for Health Care Professionals website (CignaforHCP.com)? 

When you use this helpful feature, you can:

• Avoid having to call customer service to request an adjustment.
• Save time – no need to mail or fax in your request and documentation.
• Use the notes section to explain your request.
• Upload attachments easily for requests that require supporting documentation.
• Confirm that your request has been received.
• Check the status of your request online.

READ MORE 

Educational Opportunities
You’re invited to join interactive, web-based demonstrations of the Cigna for Health Care Professionals website (CignaforHCP.com). Learn how to navigate the site and perform time-saving transactions, such as eligibility and benefit inquiries, claim status inquiries, electronic funds transfer (EFT) enrollment, and more. There is also a special training session for website access managers. The tools and information you’ll learn about will benefit you and your patients with Cigna coverage.

Preregistration is required for each webinar.

READ MORE 

Specialty Medicine Injectables with Reimbursement Restrictions
Our Specialty Medical Injectables with Reimbursement Restriction guidelines state that certain injectables must be dispensed and their claims must be submitted by a Cigna-contracted specialty pharmacy, unless otherwise authorized by Cigna.

The reimbursement restriction:

• Applies when the specialty medical injectable is administered in an outpatient hospital setting.
• Applies to specialty medical injectables covered under the customer’s medical benefit.  Coverage is determined by the customer’s benefit plan.
• Does not apply when the specialty medical injectable is administered in a provider’s office,
  non-hospital-affiliated ambulatory infusion suite, or home setting.

Specialty Medical Injectables with Reimbursement Restriction list expansion
We recently expanded the Specialty Medical Injectables with Reimbursement Restriction list to
include the specialty medical injectable listed below.* 

NAME: Opdualag™ (nivolumab and relatlimab-rmbw)
DATE ADDED: May 1, 2022

Additional information
To access the Specialty Medical Injectables with Reimbursement Restriction list, log in to the Cigna for Health Care Professionals website (CignaforHCP.com > Resources > Reimbursement and Payment Policies > Precertification Policies > List of Specialty Medical Injectables With Reimbursement Restriction). We recommend you review this list frequently, as it is subject to change. Specialty medical injectables may be added upon U.S. Food and Drug Administration approval.

Master Precertification List for Health Care Providers

July 2023