Planned Medical Policy Updates
Clinical, Reimbursement, and Administrative Policy Update
- For dates of services on or after October 15, 2022, reimbursement for claims submitted modifiers CO and CQ that was provided by PT or OT assistants will be decreased by 15%. This update is agreed upon with the industry reimbursement for services, including the Centers for Medicare and Medicaid Services (CMS) National Physician Fee Schedule.
- For dates of services on or after October 15, 2022, the bills with Current Procedure Terminology (CPT) codes 11042, 11043, 11044, 11045, 11046, and 11047 will be administratively rejected if they have been issued with a stage 1 or stage 2 pressure ulcer diagnosis without a stage 3 or stage 4 pressure ulcer diagnosis.
Message Center and Claim Status Notifications
You will soon get the opportunity to receive notification of changes in the status of the claim. It will be possible to use this function via email and the new Message Center on CignaforHCP.com (https://cignaforhcp.cigna.com/ ) for registered providers with the Claim Search entitlement. The settings will allow you to see daily or weekly updates after a claim is processed, pending, or rejected.
News for Routine Vision Services from EyeMed
Cigna becomes a partner of EyeMed for the management of routine vision services for their customers nationwide, beginning January 1, 2023. These services include eye examinations to check vision by eye care professionals, disease screening, and updates of prescription eyeglasses. Some coverage will also include hardware (frames, lenses, or contact lenses). It will depend on the benefit plan design.
Areas of EyeMed’s Responsibility
– Direct contracts with optometrists and ophthalmologists for routine vision on Cigna’s network.
– Claims processing and payment.
– Handling all customers’ inquiries.
To affected providers, this means that
~ Providers must be contracted with EyeMed for the provision of intranet routine vision services to patients with Cigna coverage from January 1, 2023.
~ This will have no effect on eye care services provided to Cigna customers under their contracts, including the treatment and management of eye conditions and diseases.
*If you are interested in joining EyeMed, WCH is here to assist you!
In-network Care under a Strategic Alliance Plan
You should be aware that a patient may present an ID card from a company whose network-participating provider you are not. However, if the Cigna name appears anywhere on the patient’s ID card, it could indicate that the health plan is in a Cigna strategic alliance, making your care intranet.
It is noteworthy that patients with strategic alliance plans are treated on the same terms as patients with other Cigna medical plans. The Cigna agreement covers them all.
– MVP® Health Care
– Priority Health
Tobacco Cessation Campaign
Cigna encourages its’ clients not to stop identification screens and treatments for tobacco dependence during annual patient visits to the Wellness Center. If such a service is performed by a participating provider, it is covered at 100% with no patient cost participation.
Diabetic Retinal Eye Exam