IDENTIFYING THE CIGNA PARTICIPANT

Establishing participant eligibility for benefits prior to initiating treatment is essential to ensure claim payment. Participants are not required to obtain prior benefit authorization for routine outpatient care, including diagnostic or initial treatment sessions. Participants may visit the online Provider Directory at www.cignabehavioral.com to search for practitioners or may contact us through the mental health and substance abuse telephone number on their medical identification card. However, coverage for any higher level of care must be preauthorized. Practitioners are responsible for obtaining prior authorization for non-routine outpatient care as well as for all higher levels of care. The practitioner may not bill the participant for care for which prior authorization was not obtained, beyond applicable coinsurance/copayment and/or deductible.

Not verifying eligibility and benefit coverage can result in an administrative denial, whereby the practitioner must hold the participant financially harmless if the practitioner was aware of or failed to determine the participant’s coverage. If a participant does not have a health care identification card, ask the participant for the information below. Then call CIGNA or go online to www.cignabehavioral.com to verify eligibility and benefits for the participant.

Participant Information
Participant Name
Zip Code
Date of Birth
Subscriber ID #

Plan Subscriber Information Name
Participant Number
Subscriber ID #
Date of Birth
Zip Code

Participants enrolled in PPO, OAP, and HMO plans may select a practitioner from a network Provider Directory and are not required to secure prior benefit authorization from CIGNA for routine outpatient services. Preauthorization of coverage and care management of inpatient, partial, residential and IOP services for PPO, OAP, and HMO participants are still required and must be obtained by the practitioner. Benefits, coinsurance, claim information, and the claims filing address are prominently listed on the participant card.

A practitioner contracted with CIGNA must treat all CIGNA participants equally, and must behave as contracted, regardless of service location. You may not require that CIGNA participants sign self-pay agreements prior to providing covered services to those participants, unless you specifically set forth in detail to the participant and the participant agrees to pay for those specified behavioral care services in writing prior to the delivery of those behavioral care services, nor may you charge CIGNA participants out-of-network rates. Please refer to your CIGNA Participating Provider Agreement for additional information.

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