CIGNA PPO timely filing limit will adopt a common time frame for health care professionals to follow for submitting claims to CIGNA.
Except where state law requires a longer time frame, the claim filing limit will change from 180 days to 90 days for participating health care professionals.
The changes to the claim filing time frame will occur in phases, with the initial phase effective on August 1, 2011
Providers will be notified in writing of any changes and receive an amendment to their agreement, or they will be contacted by a CIGNA representative.
The claim filing time change also applies to health care professionals whose CIGNA contract includes GWH-CIGNA business.
Certain states have regulatory requirements that supersede the CIGNA time frames, and health care professionals in these states will have a claim filing limit that meets state requirements.
* When CIGNA is the primary payer, claims must be received by CIGNA within 90 days of the date of service to be considered for payment.
* When CIGNA is the secondary payer, the claim must be submitted within 90 days of the receipt by the health care professional of the Explanation of Payment from the primary payer.
Only participating health care professionals who receive a notification and amendment to their agreement from CIGNA, or who are newly contracted with CIGNA, are affected by this change on August 1 and November 1, 2011.
There will be additional phases in 2012, and affected health care professionals will be notified in advance of any changes.
Effective August 1, 2011, the claim filing limit in provider agreements will change from 180 days to 90 days, for participating health care professionals who have received notification and an amendment to the agreement in AK, AR, AZ, CO, CT, DE, IL, IN, KS, LA, ME, MI, MO, NH, NY, OH, OK, RI, SC, TX, UT, VT, WI and WV.
Effective November 1, 2011 for CA, GA, KY, MA, MS, NV, PA, TN and WA.
NY and TN will have a 120-day claim filing limit.
TX will have a 95-day claim filing limit.