The Practitioner Connection
Volume XXX, 2nd Quarter

2008 TREATMENT RECORD REVIEWS

CIGNA standards for individuals receiving mental health or substance abuse services with contracted network professionals include treatment records that are confidentially maintained, current, detailed, organized, and allow for quality review. CIGNA monitors the treatment record-keeping practices of selected high-volume psychiatrists and therapists to ensure 80 percent compliance with documentation standards.

COULD YOUR RECORDS PASS AN EAP AUDIT?

Recent audits of EAP provider records reveal some common strengths and weaknesses. Would you pass an audit of your EAP client records? Following this quick guide should help insure your records would make the grade.

EFFECTIVE COMMUNICATION SERVES APPROPRIATE AUTHORIZATION

When an authorization for coverage is in question, a peer-to-peer discussion between a CIGNA medical director and the facility attending physician (or designee), is the vehicle through which we determine the appropriateness of reimbursement for services. CIGNA conducted a Six Sigma study that suggests personal contact rather than written information, and physician to physician conversation are most effective where clarification for a coverage authorization is needed.

MEDICATION NON-ADHERENCE IN SCHIZOPHRENIA

Medication non-adherence remains significant and a common problem in treating individuals with schizophrenia. This article will briefly discuss some of the more common reasons contributing to medication non-adherence, along with ways of improving adherence.

NEW MIXED SERVICES PROTOCOL

A new Mixed Services Protocol for claims administration of medical and behavioral claims went into effect on April 15, 2009. This article offers information on how the new protocol may affect your claims submission.

ENSURING ZIP CODE ACCURACY

Ensure claim forms include accurate ZIP codes to avoid payment and outgoing correspondence delays.

2008 KEY FINDINGS OF THE QUALITY AND UTILIZATION MANAGEMENT PROGRAM

The effectiveness and efficiency of all Quality and Utilization Management activities are evaluated annually to identify improvements, barriers to success, and to establish future goals. During the 2008 program year, CIGNA demonstrated statistically significant improvements in the following two national clinical and two national service measures and has identified priorities and opportunities for 2009.

"CIGNA" and "CIGNA HealthCare" are registered service marks of CIGNA Intellectual Property, Inc., licensed for use by operating subsidiaries of CIGNA Corporation.” Products and services are provided by these operating subsidiaries and not by CIGNA Corporation. These operating subsidiaries include Connecticut General Life Insurance Company, Tel-Drug, Inc. and its affiliates, CIGNA Behavioral Health, Inc., Intracorp, and HMO or service company subsidiaries of CIGNA Health Corporation and CIGNA Dental Health, Inc. In Arizona, HMO plans are offered by CIGNA HealthCare of Arizona, Inc. In California, HMO plans are offered by CIGNA HealthCare of California, Inc. In Connecticut, HMO plans are offered by CIGNA HealthCare of Connecticut, Inc. In Virginia, HMO plans are offered by CIGNA HealthCare Mid-Atlantic, Inc. In North Carolina, HMO plans are offered by CIGNA HealthCare of North Carolina, Inc. All other medical plans in these states are insured or administered by Connecticut General Life Insurance Company.

808353 10/07 ©2009 CIGNA