Common Claim Issues

Check Eligibility and Benefits
Call the number on the participant’s card or go to our web site at www.CIGNABehavioral.com to confirm eligibility and verify benefit information.

Prompt Submission of Claims
It is best to file a claim as soon as possible after care has been provided.

Mail to Correct Address
There are many different addresses to which claims may be submitted. It is best to call the number on the participant’s ID card to determine where to send behavioral health claims for processing. The address that is printed on the participant’s card is most likely for medical claims, so please understand most claims for behavioral care services should not be automatically sent to that address.

Coordination of Benefits (COB)
Requesting COB information at the time of the participant’s visit could eliminate unnecessary claim processing delays. COB forms are available via your Practitioner Resource packet and/or through our Provider Advocacy Department by calling 800.926.2273.

Diagnosis Code
While the DSM-IV is a great clinical tool, and closely resembles the ICD-9-CM, it does include codes that have been eliminated from the ICD-9-CM and/or are invalid. Most insurers now use ICD-9-CM coding for claims reimbursement. Due to federal HIPAA regulations, we are no longer able to accept claims with outdated and/or invalid codes. Claims submitted using outdated diagnostic codes will be denied. To determine the most current codes be sure to use the latest version of the ICD-9-CM.

Procedure Codes
All claims must be submitted using valid procedure codes. Due to federal HIPAA regulations, we are no longer able to accept claims with outdated and/or invalid procedure codes. Claims submitted using outdated codes will be denied. To determine the most current codes be sure to use the latest version of the CPT coding books or contact our Provider Advocacy Department by calling 800.926.2273.

Complete "Clean" Claim Form
Make sure all information below is included on the claim form to help facilitate correct and speedy claim payment:

• Employee Name	• Policy Holder's SS # or Member ID
• Participant Name	• Participant's Date of Birth
• Procedure Code	• Diagnosis Code (ICD-9-CM)
• Dollar Amount of Service	• Date of Service
• Practitioner's Address	• Practitioner's Tax ID Number
• Practitioner's Name and Credentials

Web Claims www.cignabehavioral.com
We offer an enhanced web site to which claims may be electronically submitted, where claim status may be checked and which pre-populates form fields (behavioral or EAP) for subsequent claims. The system is set up to automatically notify you if a claim is missing pertinent information. The standard turnaround time for web-submitted claim processing is 7-10 business days. If you have any questions regarding web claims, please contact our eCommerce lines by calling 1.888.259.6279.

Common Claim Form Problems

Box 25. Ensure the number being entered into box 25 is either a SSN or EIN and clearly indicate which by checking the appropriate box.
Box 31. Make sure name is printed legibly. A signature is not required.
Box 33. Make sure the address listed is the billing address we have on file for the SSN or EIN entered in Box 25. You can always check the website to verify service addresses.

 

   

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If you have topics you'd like to see addressed here please let us know. Contact us at NetworkDevelopment@cigna.com and we'll dig into them. We want this brief to be as informative and insightful as possible and to address topics important to our practitioner community.