The Practitioner Conection
Volume XXVI, 2nd Quarter

MEDICAL MANAGEMENT PROGRAM

The CIGNA Medical Management Program (formerly known as the Provider Guide) is an informative resource for providers and practice administrators when working with CIGNA members. Additionally, it is an extension of the Participating Provider Agreement, so it is important to be aware of the information within the Medical Management Program (MMP) as it impacts your relationship with CIGNA. The following is an overview of the Medical Management Program and the accompanying Provider Guide. You can access the MMP by visiting our website, www.cignabehavioral.com; click on ‘Providers’ on the left side of the page and then click on ‘More’. This will bring you to the Provider home page where you can select ‘Medical Management Program’ on the left side of the page. For ease of use, information is listed by licensure level to indicate what content might be most helpful for master’s level, PhD level and MD level providers. In addition, content used for administrative and billing offices is also listed. The following is an overview of the information found within the MMP.

After a brief introduction, the MMP covers the process of initially credentialing with CIGNA and the procedures for keeping information such as practice address, phone and TIN updated and accurate (Section 2). Next, the MMP reviews information about CIGNA's Care Advocacy Program (Section 3), which is based on our core values of Compassion, Expertise, Service and Integration. The processes and procedures detailed within this section of the MMP reflect those values. You will also find a wide variety of topics, from basic information to a detailed description of Authorization Guidelines and Appeals. Another important topic included in the MMP is claims payment (Section 4). The reader will find a review of how to confirm a member’s benefits, instructions on the claims process and instructions on the different methods to submit claims to CIGNA. Additional information in the MMP includes descriptions of CIGNA's quality programs (Section 5), such as high volume medical record reviews and product information (including coordination with Medicare).

Another important component of the MMP is the various Appendices. Appendix B: Claims Information provides detailed information on the CMS 1500 and UB 04 forms. Many claims issues can be avoided by following the instructions listed within the MMP. A detailed description of CIGNA's Explanation of Benefits is also provided in this section. Finally, a Coordination of Benefits (COB) form is included to facilitate timely claims payment.

Appendix D: CIGNA Behavioral Health Practitioner Forms, can be very useful when working with a CIGNA member. In this section, you will find an update form to keep your information current with CIGNA, as well as a W9 form in case of Tax ID changes. Additional forms include an example of a Self Pay Agreement and an Informed Consent document, as well as the questions used for the high volume medical record review. Specific forms related to EAP are located in Appendix E: Employee Assistance Program (EAP) Forms. Appendix G: Primary Care Physician (PCP) Communication Information is another important reference section of the MMP. This section includes a sample Release of Information to facilitate communication with a participant’s primary care physician and/or other medical providers. Additional topics, such as contact information and participant rights and responsibilities, are covered in some of the other appendices. All of the forms in the appendices are for provider use.

The Provider Guide is also included to provider state specific information for those states with certain specific guidelines. The states currently included are California, Maine, Massachusetts, New Hampshire, New Jersey, North Carolina, Texas and Vermont.

The MMP goes through a quarterly revision process to ensure that the information remains current and accurate. For questions regarding any of the information on the Medical Management Program, please contact your Provider Relations Department.

Other Featured Articles:

KEY FINDINGS OF THE QUALITY AND UTILIZATION MANAGEMENT PROGRAM

AUTISM AND OTHER PERVASIVE DEVELOPMENTAL DISORDERS

EAP SUBSTANCE ABUSE ASSESSMENT AND MANAGEMENT REFERRALS

PREVENTIVE HEALTH PROGRAMS

PROVIDER SATISFACTION SURVEY

CLAIM OFFSETTING PROCESS

GAPS IN CARE FOR BIPOLOAR DISORDER

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