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is being recorded and welcome to the new provider orientation my name is anna and i'm a behavioral provider relations representative here at cigna i look forward to spending the next 30 minutes talking to you about working with cigna this orientation is geared towards individual providers and clinics please do not feel that you have to write down all the contact information i present to you today the welcome to the network email that you recently received includes all the highlights that we'll cover including phone numbers email addresses and websites cigna's mission is to improve the health well-being and sense of security in the people that we serve because you play such a vital role in the health and well-being of our customers it's a priority to us to develop long-lasting and productive relationships with healthcare providers my goal in this orientation is to give you the tools you need to start working with cigna the provider services team is designed to be a one-stop shop in addressing your questions and concerns advocates can assist you with eligibility and benefit quotes status inquiries claim status checks and problem resolution they can provide basic information on initiatives that may be of interest to you joining the network information they can also triage calls to get them to the appropriate team members and are serving as your initial point of contact they can be reached at 1-800-926-2273 the provider relations team is dedicated to improving your experience working with cigna we're working with you as well as behind the scenes to make working with us easier please contact your pr app if you have any questions about your contract if there's questions that an advocate wasn't able to resolve but you can also feel free to ask for your pr at any time to find the prep covering your state please see the cigna behavioral health key contacts flyer in the welcome to the network email that you recently received our after hours team is available for after hours crisis situations only you can reach them by calling the provider services number that number again is 1-800-926-2273 this team is not available for administrative questions it does include advocates care coordinators and clinical care managers our medical management program or mmp is where you'll find all the information we're covering in the presentation today the cigna behavioral medical management program or mmp is an extension of your contract and is referenced in your participating provider agreement it's divided into two sections an administrative guide and a state specific section it also includes helpful forms such as the primary care physician communication information form a self-pay agreement a coordination of benefits form amongst others you can access the mmp at our website cignaforhcp.com in the resources section mmp is updated quarterly let's move next to the credentialing process you're either in the middle of that process or you just completed it sigma verifies all information with ca qh please respond to any request from cigna regarding your profile once your caqh profile is completed and has been attested it will be released to cigna for review and final credentialing this process can take anywhere from 45 to 60 days from the credentialing date while in the credentialing process you are only in network for patients with html plans employee assistance programs and the integrated policies please call in to verify your in-network status prior to seeing any signal members you will receive notification for any upcoming re-credentialing at the mailing address that we have on file for you this notification will be sent out six months in advance the re-credentialing date please note that most states require this every three years however some states do require re-credentialing every two years as a contracted provider with cigna you are considered in network wherever you render services your contract with segment is specific to you rather than to a specific location or taxpayer identification number or 10. if you are a contracted individual provider who also works at a non-contracted group practice your services would be considered in-network regardless of the service location or billington for more information on this please review the behavioral medical management program on our website signat4hcp.com again it's in the resources section for demographic changes if there are changes to your clinic's address telephone number or leadership team please contact provider services as soon as possible to make those updates they'll update your profile or amend your contract accordingly please note that addresses updated in caqh are not sent to cigna you must contact cigna directly with address changes you can call provider services at 1-800-926-2273 to add active service locations to your file as well cigna has a number of product offerings including hmo ppo or open access plus standalone employer products it's important to contact cigna whenever you receive new patient to verify their benefits benefits will vary based on the product type amongst other factors the provider advocate can confirm the correct claims payer with for each new signed behavioral patient cigna also maintains alliances with other healthcare companies that access our network claims for alliance customers are paid by the health company that manages the benefits for more information about our alliances please refer to the behavioral medical management program found on cigna for hcp.com you can look in the resources section the last product offering that i want to mention is cigna health health spring hmo and ppo cigna health spring markets are not nationwide please refer to the mmp to see if healthspring is offered in your state you can tell if you're in network for cigna health spring via your participating provider agreement with cigna you can outreach our health spring provider service team for inquiries about the plans at 800 800-230-6138 they can help with claims and claims revolution eligibility and status checks billing inquiries they can provide basic information on initiatives that may be of interest to you as well as serving as your initial point of contact regarding health spring next i want to talk about our care advocacy process when seeing a new cigna member please ensure that you make a copy of the patient's id card call the telephone number on the back of the id card to check eligibility and benefits confirm the claims address and confirm if the patient is using their employee assistance program or eap you can also check eligibility benefits and some claim status on cigna's website cignaforhcp.com for authorization requirements for cigna there is no pre-authorization required for routine care including medication management individual group therapy you'll want to call the patient's medical carrier for psych and neuropsychological testing authorization requirements outpatient reviews may be required occasionally you'll want to make sure that you're contacting cygnus within seven days of receiving a letter requesting a clinical review pressing the health spring pre-authorization is not required for most routine care again things like medication management individual and group therapy you'll still want to contact the medical carrier for psych and neuropsych testing authorization requirements due to mental health parity requirements it is critical that you call in to confirm eligibility and benefits for every patient it's also important to call in at the beginning of every new year for existing patients to see if their benefits have changed you are all considered in network for our routine services but i do want to take a moment to discuss sigma's other access levels we have routine care which requires no pre-authorization intermediate care which is an appointment within 48 hours of a request lastly we have crisis stabilization which is an appointment within six hours of the request price of stabilization is divided into two categories 24 7 and non 24 7 options sigma supports the concept that all licensed behavioral health practitioners by virtue of their license are competent to treat most behavioral health disorders some disorders testing and participant groups are better treated by practitioners with special knowledge and skills in such areas in order to claim a specialty in these designated areas practitioners must meet one or more of the education or experience requirements for each of the listed specialty disorders treatment modalities or populations for most specialties the practitioner simply signs an attestation form that they meet their requirements signal will only refer participants needing a specialty service to those participants who have listed the specialty if you are a clinic and have clinicians who did not notify us of their specialty or in any of these services they can complete a specialty network worksheet located in the medical management program in appendix f as a participating provider with sigma behavioral you are automatically identified as a provider with eap assessment and referral specialty unless you chose not to participate while completing your provider application approximately 20 million cigna customers nationwide have access to our standard eap or to a bundled solution for short-term counseling and work-life resources by participating in this specialty network you can perform eap services which include short-term counseling that focuses on problem identification and resolution you can also refer to the appropriate resource to complete the problem resolution medication management is not included for eap claims for eap services should always be sent to cigna behavioral again please note that eap services cannot be offered by psychiatrists by providing these eap services you can potentially broaden the scope of your practice supplement your income with sessions into a wider patient population and also expand the access to behavioral health services in your community i want to go over some administration tips for eap benefits sessions are separate from the behavioral health benefit plan so no co-pay is required from the customer to utilize their eap benefit a cigna customer must obtain an eap authorization from cigna and they must provide this to you prior to their first counseling session you should not provide eap services unless you have an eap authorization number you may call provider services to verify an authorization number as well as the number of sessions available you'll want to use the cpt code 99404 to ensure appropriate payment each eap authorization covers one issue per individual per plan year if the cigna customer presents to you with a new issue within the same year prior to treatment please contact cigna to obtain a new authorization number eap is not meant for long-term treatment or therapy claims must be submitted promptly after each eap visit to comply with family filing requirements please call provider services to check eligibility or to request an eap authorization and to close the patient's eap case once you've completed it telehealth benefits for behavioral telehealth sessions are administered in accordance with the customer's benefit plan telehealth sessions may be used for therapy or medication management behavioral telehealth is available as an alternative service method by treatment providers who meet the telehealth specialty requirements visit cigna's website cignaforhcp.com you'll go to the resources section forms center behavioral health forms to find the attested specialty form to add the telehealth specialty to your profile when submitting claims you'll want to use the appropriate cpt code and include the modifier g t in the field 24 d of a claims form this modifier specifies that the service is a telehealth session you'll use your existing fee schedule to determine the correct charge once you're fully contracted we encourage you to register on our website cignaforhcp.com to verify your contract status you can call provider services at 1-800-926-2273 once registered you can log onto the website and verify benefit plans for html and ppo members check claim status update your information and much more we would also like to encourage you to check out our web tutorials our goal is to provide you with a positive online experience you can find our behavioral education and training page at cignaforhcp.com you can learn how to navigate the website verify patients eligibility and benefits perform claims inquiries register for eft and much more i want to take a few minutes to go over some basics around claim submission there's a detailed section in the mmp devoted to claims payment in addition to an appendix and helpful claim forms one important note about claims before we move on is the coordination of benefits form this will be requested for the first claim of the year for all signet customers it is the customer's responsibility to advise advise us of any secondary coverage but it can slow your claim payment process down if they're unresponsive you may want to ask your participant or your patients excuse me to fill out the coordination of benefits form at the beginning of every year and have it on record if you have the assigned form you can submit it to cygnus to help ensure that your payment is not delayed due to lack of information about other benefits you can find the coordination of benefits form in appendix d of the medical management program you'll also want to take note of the timely filing time frames outlined in your contract and they can vary state by state our self-pay agreement is also available for services that are rendered that are not covered by the customer's benefit plan that would be things such as a missed appointment fee this form can be found in our mmp you can find more information about billing code guidance and prior authorization requirements in the authorization and billing resource on our website again cigna for hcp.com you'll go to the resources section behavioral resources doing business with cigna i want to point out a couple of common issues when working with the cms 1500 form in box 31 you may want to print your name as opposed to signing it you may also want to make sure you're including your claims mailing address as it's listed on your w-9 these simple steps can help ensure that your claim is processed quickly i also want to go over the required information on a claim form please make sure to include the employee name the patient name the patient's date of birth an identification number such as their social security number or alternative medical id number if the patient does not want to give either of those identifiers you can use the signet id and the date of birth you'll also want to include the type of service the date of service the charge for the service the diagnosis the treating provider including license and credentials the taxpayer identification number or tin of the provider clinic or facility the provider's signature the admitting diagnosis is required for an emergency room claim and an npi is required for electronic submissions participating in an electronic data interchange or edi can help ease your administrative burden you can submit claims electronically with less processing errors edi vendors also allow you to receive electronic eligibility and benefits information working with an edi vendor may also reduce your paperwork and generate faster claim delivery than traditional mail you'll also be able to receive electronic remittance advances cigna's payer id for adi is 62308 you can find a list of our vendors on our website cigna.com edi vendors for sigma health spring you can still use edi there is a different payer id 63092 you can send paper claims for health spring using the cms 1500 form to po box 981706 el paso texas 79998 you can also sign up for electronic funds transfer eft for health spring you can go to cigna dot com slash medicare cigna dash help spring you'll go to solutions for health care providers current provider manual and then you'll go to eft enrollment process eft is basically just direct deposit it electronically deposits claim payments directly into your bank account some of the benefits are that it eliminates a paper check you have access to the funds on the same day that th y're deposited you can view separate remittance reports online for each deposit and it can help easily reconcile payments using a single remittance tracking number to sign up for eft for cigna you can enroll two different ways you can enroll directly with caqh for multiple payers including cigna on their website or you can log on to cigna's website cignaforhcp.com and log in and sign up for eft directly with just cigna you'll go to working with cigna enroll in electronic funds transfer options lastly i want to mention our newsletter transformations it is a bi-monthly newsletter delivered right to your inbox it'll help you keep up to date with featured industry information administrative updates plan coverage and other helpful tips on behalf of cigna i want to thank you for your interest in our network and listening to our new provider orientation we hope you found this information valuable and it will help you to administer benefits to your sigma patients we encourage you to refer to your welcome to the network email which covers the highlights we discussed including phone numbers email mailing addresses website and more thank you again