Quick Reference Guide - MVP Health Care

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Quick Reference Guidefor MVP National Alliance with CignaSince 2007, MVP formed an alliance with Cigna to allow MVP’s upstate New Yorkprovider network to provide in-network care to Cigna members.Provider contracts have been amended to allow MVP providers to see Cigna customersat in-network rates. Your MVP contract fee schedule will apply for covered servicesrendered to eligible Cigna members.Cigna members will continue to use the Cigna network for the following services: Behavioral Health Dental Care Pharmacy Routine Vision Services TransplantsPlease note:As of March 31, 2016, Cigna members are ableto access the MVP optometry network for nonroutine vision services.For outpatient lab services, MVP providers should refer Cigna members to Quest, LabCorp orMVP-participating hospitals. A copy of a sample Cigna ID card is shown below.Cigna members seeking health care services should present this or a similar CignaID card to you at every visit.myCigna.comwww.Cigna.comPPOIIN 12345B Control 00600000SpecialistUrgent CareName:UO1234567 01Joe CustomerRx 10/20%/40%/100%Rx Indiv Deduct 50MultiPlanContacting Cigna to confirm coverage, obtain precertification forspecific services and for claim inquires:Where to CallCigna has one number to call to confirm eligibility, obtain benefit coverage information,precertification requirements, or for any claim submission or coverage questions. Pleasecontact Cigna at 1-800-Cigna24 (244-6224).Over

Quick Reference Guidefor MVP National Alliance with Cigna (continued)Use Cigna’s WebsiteCigna also offers online tools to obtain answers to these potential questions, and more.Please visit www.cignaforhcp.com to view the tools that Cigna offers to providers treatingCigna members. An online demo is available for you to see how to register and use thewebsite.Where to Submit Claims for Cigna MembersPlease use the following claims address for paper claims submission:CignaP.O. Box 182223Chattanooga, TN 37422-7233Receiving payment from CignaYou will receive payment from Cigna for covered services rendered to Cigna members,provided all precertification and claim requirements are met. Your MVP reimbursementschedule will be used to process claim payment for these services. Please note that whenpayment is received, you cannot bill the Cigna member for an additional amount.You and the member will receive an Explanation of Medical Benefit from Cigna that will havethe following note on it in such instances:EOP CODE 1349 - “Thank you for using the MVP Health Care Network. Thisrepresents your savings, so you are not required to pay this amount. This provider isprohibited from billing the patient for the difference. If you have already paid thefull amount, please request reimbursement from your provider.”Provider AdvocacyIn the unlikely event that you or your office staff have been unable to resolve a claimpayment issue with Cigna, we are happy to help. Please contact MVP’s Provider ClaimService Center at 1-800-684-9286. We’ll investigate the situation and offer assistancewhenever possible.Over

Quick Reference Guidefor MVP National Alliance with Cigna (continued)Cigna’s Other AlliancesIn addition to Cigna’s alliance with MVP, Cigna also has similar alliances with TuftsHealth Plan, HealthPartners, and Health Alliance Plan.Members of these plans will have the Cigna logo on their card (and in most cases theMVP logo will also be printed), and should be treated no differently than MVP andCigna members.If a member of one of these health plans presents for services with an MVP provider,they can contact that health plan directly by calling the toll-free number on the back ofthe member’s ID card to verify benefits and eligibility, and submit claims directly to thathealth plan either electronically or on paper to the claim address found on the back ofthe ID card.

Frequently Asked Questionsfor MVP National Alliance with CignaQ:I have a patient with a Cigna ID card that doesn’t have the MVP logo on it. How can Iidentify whether or not I can treat that member under the Alliance?A:ID cards include the MVP logo when Cigna members have access to the MVP networkand when the subscriber on the policy resides within the MVP service area.ID cards may not include the MVP logo when Cigna members have access to the MVPnetwork and the subscriber on the policy resides outside of the MVP service area (e.g., asubscriber may live in San Diego, but has a dependent student attending college inSyracuse).Therefore, the key is that all Cigna members who have access to the MVP network willhave either “Cigna PPO,” “Cigna OAP,” or “Cigna Open Access Plus” printed on their IDcards.Providers should always verify benefits and eligibility before treating either a Cigna orMVP member.MVP Members: www.mvphealthcare.comCigna Members: www.CignaforHCP.comQ:Are there any services that are excluded from the Alliance, and if so what does it mean forMVP-participating providers?A:Routine vision services, transplant services, and behavioral health services are not coveredunder MVP’s alliance with Cigna. For more information about these services, pleasecontact Cigna by calling the phone number listed on the back of the member’s ID card. Routine vision benefits for Cigna members are administered by VSP. Transplant benefits for Cigna members are administered by Cigna LifeSOURCE. Behavioral Health benefits for Cigna members are administered by CignaBehavioral Health (“CBH”).Over

Frequently Asked Questionsfor MVP National Alliance with Cigna (continued)Q:How do providers identify that they are part of the Alliance when using Cigna’s website?A:Providers may verify their network status for Cigna members by using Cigna’s directory atCignaforHCP.com. Selecting the member’s product will ensure accurate results.Q:I need to submit an appeal for a Cigna member. Where do I send it?A:If you need to submit an appeal related to an adverse determination rendered by Cigna,please submit the appeal in accordance with the instructions provided in the adversedetermination letter from Cigna.Q:What policies (administrative/medical/precertification) should MVP-participatingproviders follow when treating Cigna members?A:Coverage criteria & precertification requirements follow Cigna guidelines, whileadministrative requirements follow MVP guidelines.Q:What counties in Upstate New York can Cigna members access the MVP participatingprovider network?A:Cigna members can access MVP participating providers in the following New Yorkcounties, which are shaded in red on the map found on the following page. Cignamembers must use providers contracted directly with Cigna in the counties shaded ingreen and orange on the map found on the following ansOswegoOtsegoRensselaerSt. mingYatesOver

Frequently Asked Questionsfor MVP National Alliance with Cigna (continued)All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and LifeInsurance Company, Connecticut General Life Insurance Company, Cigna Behavioral Health, Inc., and HMO or service company subsidiaries of Cigna HealthCorporation. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. 2016 MVP Health Care

MVP Health Care Cigna Quick Reference Guide 3-12 Author: MVP Health Care Subject: MVP Health Care Cigna Quick Reference Guide 3-12 Keywords: MVP Health Care, Cigna, Quick Reference, Guide, Provider, 2012 Created Date: 11/30/2016 12:37:34 PM

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