Wednesday, June 22, 2011

Enhancements to CIGNA's benefit plan options & administration effective July 1, 2011

CIGNA is making the following enhancements to their benefit plans as of July 1, 2011.

National Radiology Network Management
CIGNA has engaged MedSolutions, Inc., to provide MRI, CT and PET scans at competitive rates through its national network of radiology centers and to review and manage non-emergency MRI, CT and PET scans for all CIGNA administered plans in the United States effective July 1, 2011. This is an exclusive contracting arrangement. We will be implementing the change to MedSolutions from all other radiology network vendors in a staged approach through the end of this year. CIGNA’s new national agreement with MedSolutions is designed to provide savings to our clients and a consistent experience for your plan participants.

Informed Choice Outreach Program
MedSolutions administers a patient support and outreach program called Informed Choice. The goal of the program is to educate patients undergoing an MRI, CT or PET scan about their options for geographically convenient and cost-effective facilities as they and their doctors choose where to have the tests done.

After a physician contacts MedSolutions for precertification of coverage of an MRI, CT or PET scan, a specially trained representative may contact the individual by phone and provide information about conveniently located credentialed participating facilities (hospitals or free-standing facilities) and offer appointment options. MedSolutions representatives can also provide cost comparison information, so that individuals are aware of the financial impact of their choices.

MedSolutions can assist in scheduling an appointment at the individual’s facility of choice and complete the referral for the services that have been authorized for coverage. In addition, if the individual has additional questions about benefits, account-based balances (e.g., HRA or HSA), or other plan details the MedSolutions representative can connect directly with CIGNA’s customer service team.

This proactive outreach occurs only when true opportunities for choice exist, such as when the ordering physician has requested a higher cost radiology center or hospital for services and other participating credentialed centers offer the same services at a lower cost.

Nuclear Cardiology Services Review and Precertification
Also effective July 1, 2011, MedSolutions will provide expert clinical review of nuclear cardiology services to ensure compliance with our clinical guidelines. The MedSolutions program is designed to promote appropriate care for patients planning to begin a nuclear cardiology treatment plan

Precertification of all outpatient, non-emergency cardiac nuclear studies will be required effective July 1, 2011 and it is the responsibility of the referring in-network health professional to obtain this precertification. Health care professionals contracted with CIGNA have been notified of this new precertification requirement.

Precertification of Outpatient Services
CIGNA requires network providers to obtain pre-certification for many outpatient services (e.g., radiology, surgery). Beginning July 1, 2011, CIGNA is changing its participating provider appeal process with respect to reimbursement for services that have not been pre-certified when required. Reimbursement will not be approved on appeal unless the health care professional can demonstrate that:

1. The services were provided in an emergency or urgent care situation; or
2. Extenuating circumstances prevented pre-certification (e.g., natural disaster, incorrect insurance information).

CIGNA’s agreements with health care professionals and facilities prohibit billing patients for charges for covered services that are administratively denied due to failure to obtain pre-certification where required. CIGNA has notified participating health care professionals of this change and is providing additional information to them in order to make this change seamless.

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