December 2021
Provider eConnection
|
|
|
IPN News and Events
that you don't want to miss!
|
|
CREDENTIALING CORNER:
IPN has recently seen an increase in credentialing applications being submitted with stamped or typed signatures. In an effort to ensure all documents are reviewed and signed by the actual practitioner, and to keep in compliance with NCQA guidelines, IPN is unable to accept signatures that have been stamped or typed. Electronic signatures can be accepted via a secure method - secure programs typically have a date and time stamp with the signature. Please ensure a physical or secure electronic signature is completed by the practitioner on each credentialing application.
|
|
IPN TRANSITION FAQs:
Q: What payors do I need to contact for services after July 1, 2022?
A: Below is a list of current IPN payors, termination dates and future plans. As IPN is made aware of other plans, the newsletter and/or website will be updated. For additional questions, contact IPNTransition@ipnmd.com. |
|
Q: Will payors be processing claims on or after their termination date?
A: YES! Most will offer run-out repricing services following their termination. Please stay tuned for updates to the Run-Out Repricing list provided in this newsletter.
|
|
RUN-OUT REPRICING
Below is a list of terminated groups for which IPN is processing run-out claims. Be sure to submit claims before the run-out period ends! For additional information about the terminated groups, contact the payor listed on the patient's ID card.
|
|
PACIFICSOURCE COMMUNICATION UPDATES
COVID-19
General Information
|
|
CIGNA COMMUNICATION UPDATES
COVID-19
Read Cigna's billing guidelines and FAQs here OR visit Cigna.com > Health Care Providers > Billing information and resources related to the COVID-19 pandemic.
Network News
Policy & Reimbursement Updates
Cigna routinely reviews coverage, reimbursement, and administrative policies for potential updates. In that review, Cigna takes into consideration one or more of the following: Evidence-based medicine (EBM), professional society recommendations, Centers for Medicare & Medicaid Services (CMS) guidance, industry standards, and our other existing policies. Below are policies that will be changing:
-
Convenience/Retail Care Services: Beginning January 1, 2022, providers should use Place of Service (POS) code 17 (walk-in retail health clinic) instead of POS code 11 (office) when billing for convenience/retail care services. This will help ensure patients with Cigna coverage have a lower or no cost share associated with services provided at a convenience care clinic. This change does not impact convenience care clinic fee schedule or reimbursement. Before collecting a cost share, verify the patient’s benefits. While some Cigna ID cards list the cost share for convenience care clinics, others only list the cost share for primary care providers, which is not always the same. If there isn’t a convenience care clinic cost share listed, there are other ways to verify benefits:
- Log in to the Cigna for Health Care Professionals website (CignaforHCP.com) and navigate to the Patients tab. Then, enter the patient’s ID number and date of birth or name.
- Call Cigna Customer Service at the number on the back of the patient’s ID card or at 800.88Cigna (882.4462).
-
Outpatient Facility Blood Draws and Venipuncture: Effective for claims processed on or after February 12, 2022, Cigna will expand the existing policy to include all provider contract types, and continue to administratively deny claims submitted with Current Procedural Terminology (CPT®) codes 36400, 36405, 36406, 36410, 36415, 36416, 36591, and 36592. Reimbursement for these routine services is included in the facility payment. Denials will include administrative appeal rights.
-
Physical Therapy Services: Effective for claims with dates of service on or after February 12, 2022, Cigna will expand the existing policy to include all provider contract types, and continue to deny services billed with Current Procedural Terminology (CPT®) codes 97016 and 97026 as not medically necessary. Medical necessity appeal rights will be available.
-
Pulse Oximetry Claims: Effective for claims processed on or after February 12, 2022, Cigna will expand the existing policy to include all provider contract types, and continue to administratively deny claims submitted with Current Procedural Terminology (CPT®) codes 36400, 36405, 36406, 36410, 36415, 36416, 36591, and 36592. Reimbursement for these routine services is included in the facility payment. Denials will include administrative appeal rights.
-
Specialty Medical Injectables: Cigna is expanding the Specialty Medical Injectables with Reimbursement Restriction list to include the following specialty medical injectables*: NEXVIAZYME® (avalglucosidase alfa-ngpt); ALDURAZYME® (laronidase) Cerezyme® (imiglucerase); ELAPRASE® (idursulfase); MEPSEVII® (vestronidase alfa-vjbk); Naglazyme® (galsulfase); REVCOVI® (elapegademase-lvlr); and VIMIZIM® (elosulfase alfa). Cigna 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 list: (i) Applies when the specialty medical injectable is administered in an outpatient hospital setting; (2) Applies to specialty medical injectables covered under the customer’s medical benefit. Coverage is determined by the customer’s benefit plan; and (3) Does not apply when the specialty medical injectable is administered in a provider’s office, non-hospital-affiliated ambulatory infusion suite, or home setting.*Cigna may grant approval for coverage of an initial dose to a facility when medical necessity is met to allow arrangements to obtain the drug from a Cigna-contracted specialty pharmacy.
-
Unacceptable Diagnosis Code: A new reimbursement policy will be implemented, Unacceptable Principal Diagnosis Codes (R38). Unacceptable principal diagnosis is a coding convention in ICD-10. Those identified codes do not describe a current illness or injury, but a circumstance which influences a patient’s health status. These codes are considered to be unacceptable principal diagnosis codes. Beginning February 12, 2022, Cigna will deny claims when an unacceptable principal diagnosis code is the only diagnosis code billed. This does not apply to Place of Service code 81 (laboratory). Denials will be administrative and include administrative appeal rights.
For more information about reimbursement or coverage policies, visit CignaforHCP.com > Resources > Clinical Reimbursement Policies and Payment Policies.
|
|
p: 866.476.1076 | f: 208.433.4605 | e: ipn@ipnmd.com
|
|
|
|
|
|
|
