ADVANTAGES OF ELECTRONIC AND WEB BASED CLAIMS

Claims submission can seem like a lot of work. It takes time to fill out forms, verify information, mail a paper copy and wait for a response. However, it is possible to cut down on submission and processing time by submitting claims via the Web or electronically.

Electronic claims are submitted through a clearinghouse. The clearinghouse works with the provider to obtain demographic and claim billing information. It is important to keep demographic information updated with both the clearinghouse and CIGNA, as it’s submitted with each electronic claim. The provider also presents service information (service date, CPT codes, etc.) and member information (patient name, date of birth, plan information, etc.) to the clearinghouse during claim submission. The clearinghouse submits claims to CIGNA electronically for benefits administration using a CIGNA-specific payer identification . This payer ID helps to identify the correct area for claim submission and ensure that the claim is handled in a timely manner. Electronically-submitted claims are checked at submission for information to help ensure accurate processing. Claims with missing patient or service information will be rejected. In general, the clearinghouse will obtain valid information and will resubmit the claim. Once validly submitted, electronic claims are normally processed within a shorter timeframe than paper claims; generally within 5 days. Since electronically-based claims are reviewed upon submission, there may be fewer errors (such as incorrect coding) that cause denials or a need for resubmission.

Web-based claims may be submitted from any computer that has internet access. The provider needs only to obtain a login and temporary password from CIGNA Health Solutions. This vetting process can be completed at any time by calling Web Customer Service at 888-259-6279. To submit web claims, the provider should log into www.cignabehavioral.com and click on the provider link, then “Submit a Claim”. From there, the provider may complete an online claim form. For security purposes, online claim forms must be completed within 30 minutes to avoid system log-out. The information required on the online form is the same information required on a standard paper HFCA. As with electronically-submitted claims, online claim forms are checked for missing information. If the information is complete the online claim is sent to CIGNA for processing. Providers can also use the same login information to view claim payment information and Explanations of Benefits.

Both electronic billing and Web-submitted claims allow for “cleaner” claims and a shorter processing time. For issues or concerns regarding electronic or web-based claim submission, please call our Web Customer Service at 888-259-6279.

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