The Practitioner Connection
Volume XXVIII, 4th Quarter
The right help at the right time!
INSURANCE IDENTIFICATION CARDS
Cigna Behavioral Health (CBH) does not produce insurance Identification (ID) cards, but partners with the participant’s medical payer. The ID card provides a wealth of information about the participant and their benefits. It is recommended that practitioners copy the card, front and back, and keep in the participant’s file for their records. It is recommended this be done annually as plan offerings and subscriber benefit elections may change.
Cards are typically issued annually, on either a calendar or contract year basis. Calendar year plans, like the name suggests, begin on January 1st and typically go through the end of the year. Contract year plans start at the beginning of any month and typically span a year. For example, if a plan’s ‘begin’ date is April 1st, the plan year would typically end on March 31st of the following year. The practitioner should be aware of the ‘begin’ coverage date as that will be the date from which benefits are tallied if the participant has yearly benefit limits. Note, some participants may have yearly and/or lifetime limits which may be accrued by visit or dollars, depending on the plan and/or the options the participant has selected.
Contacting the medical or behavioral carrier
The CBH or behavioral company telephone number is typically found on the back of the ID card and usually referenced as MH/SA. Most cards have an address indicating where claims should be sent (note, many times this is the same address as the medical payer). Some cards may differentiate between the medical and behavioral claims, so please check the ID card carefully. If a behavioral address is not listed, call the CBH or behavioral toll-free number provided, and a Customer Service Representative can give you the claims mailing address. It is recommended that practitioners review this information annually in case there is a change.
Why it's important to mail claims to the correct address
The correct mailing address can cut the time to payment dramatically, which means reimbursement for services can be provided to you sooner. It also decreases the chances the claim will go ‘astray’ if it is mailed and/or transferred between carriers.
Other useful information about the ID cards
The front of the ID card provides a wealth of useful information such as the type of insurance the member has (HMO, PPO, EPO, etc.), the coverage effective date, the member’s ID number (note, most insurers now use an Alternative Member Identification [AMI] number to identify the participant), and the participant name. Many cards have a section for copayments and/or coinsurance. These tell the practitioner, at a glance, what the copayment/coinsurance should be.
Below is a sample of one of the Cigna HealthCare cards.
Other Featured Articles:
ACCESS TO OUTPATIENT CARE
IDENTIFYING BORDERLINE PERSONALITY DISORDER
CIGNA MEDICARE ACCESS
EAP ASSISTANCE WITH WORKFORCE REDUCTIONS
TWO NEW INITIATIVES
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