Cigna Healthcare Medicare Advantage Appeals

July 14, 2023

Cigna Healthcare strives to informally resolve Medicare Advantage issues raised by providers on initial contact whenever possible. If an issue cannot be resolved informally, Cigna Healthcare offers an appeals process for resolving contractual disputes regarding preservice and post-service payment denials. This process is outlined in our 2023 Medicare Advantage Provider Manual.

Types of appeal forms

〉    Preservice form: The customer or their appointed representative (includes providers) should use this form* when they want Cigna Healthcare Medicare Advantage to rereview coverage of a medical item or service that the customer has not yet received.
〉    Post-service forms: Providers should use the appropriate appeals and disputes form** when requesting:

o  An appeal when a medical necessity determination is required.

o  A claim dispute related to a claim submission, coding, and/or contractual payment issue.

Learn more

More information about the Cigna Healthcare Medicare Advantage appeals process is available in the Participating Provider Manual.***

HealthChoice Network News – Summer 2023

July 14, 2023

HealthChoice Network News Summer 2023

In this issue
• HealthChoice contracts and a11
• EGID Network Management
• 1!11dating_Y.our billing address
• Fee schedule u11dates
• HealthChoice contact information

Anthem Provider Newsletter – July, 2023

June 30, 2023

Anthem Provider Newsletter – Missouri July 2023

This month’s featured articles:


Digital Tools 

Education and Training Opportunities 

Behavioral Health 

Medical Policy & Clinical Guidelines 

Prior Authorization 

Reimbursement Policies 

Products & Programs 


Cigna – Reimbursement Policy Update: Revenue Codes 249-259 and 637

June 28, 2023

Cigna – Reimbursement Policy Update – Revenue codes 249-259 and 637 billed without a procedure code 091723

As a result of a recent review, we will administratively deny revenue
codes 249-259 and 637 when billed without a procedure code.

Denials will include administrative appeal rights. Alternatively, providers
may rebill the previously denied revenue code with the corresponding
Current Procedural Terminology (CPT®) or Healthcare Common Procedure Coding System (HCPCS) code.

This update is effective for dates of service on or after September 17, 2023. We will update the Revenue Code Billing Requirements (R41) reimbursement policy to reflect this change.

Please click on the above link to view the complete announcement.

Cigna – Medical Policy Update: Intra-articular Corticosteriod Injections

June 28, 2023

Cigna – Coverage Policy Update – Intro-articular corticosteriod injections 091723

As a result of a recent review, we will deny intra-articular corticosteroid
injections for the treatment of chronic osteoarthritic joint pain as not
medically necessary when administered at a frequency greater than either
four in a 12-month rolling timeframe or two per day. Denials will include
medical necessity appeal rights.

This update is effective for dates of service on or after September 17, 2023. We will update the Miscellaneous Musculoskeletal Procedures (0515) medical coverage policy to reflect this change.

Please click on the above link to view the complete announcement.

Cigna Medicare Advantage – Readmission Quality Program

June 26, 2023

Effective October 1, 2023, Cigna Healthcare Medicare Advantage (MA) will implement a Readmission Quality Program. Under this utilization management program, we will reimburse for readmissions for the same or similar diagnosis at a facility under the same Taxpayer Identification Number (TIN) as indicated on the following attachment.

Cigna Medicare Advantage_ Readmission Quality Program

Arkansas Blue Cross Blue Shield – Providers’ News June, 2023

June 23, 2023

Arkansas BCBS – Providers News June 2023

This month’s featured articles:

Arkansas Blue Cross and Blue Shield

  • Alacura Agreement Ending
  • AHIN sunset – Provider enrollment, Re-credentialing, and Provider Data Maintenance
  • Cardiac Event Recorder, External Loop or Continuous Recorder
  • Carelon MOC program enhancement
  • Inappropriate prescribing of GLP-1 Agonist
  • Medical specialty medications prior approval update
  • Prepay Review of High-dollar Inpatient Claims
  • Trend Health Partners
  • Coverage policy manual updates
  • Metallic Formulary changes effective June 1, 2023
  • Standard Formulary changes effective June 1, 2023

Federal Employee Program (FEP)

  • Colorectal Cancer Screening

ARHOME & ACA members

  • ARHOME member coverage

Arkansas School Employees/Public School Employees

  • Prior Approval for reconstructive surgical services

Medicare Advantage

  • 2023 Blue Medicare webinars
  • Medicare Advantage Billing Guidelines with Relationship Codes
  • Medicare Advantage Notice of Ambulance Claim Coding
  • Health Outcome Survey

Blue & You Fitness Challenge

  • 20th Annual Blue & You Fitness Challenge is a Wrap!

Cigna – Review Program for PT and OT Effective 9/1/2023

June 19, 2023

• Effective September 1, 2023, American Specialty Health® (ASH) will begin managing the medical necessity review program for Cigna-contracted providers who provide physical therapy (PT) and occupational therapy (OT) services.

• Providers must submit medical necessity review forms and clinical treatment plans for PT and OT services to ASH via the ASHLink website (, fax, or mail.

• Cigna will continue to manage all other processes.

Please click the following link to view the entire announcement.

Cigna – Medical Necessity Review Program for PT and OT 09012023

New Century Health: Changes to your WellCare Cardiology Prior Authorizations Effective July 1 2023-Mercy Health

June 15, 2023

Wellcare is beginning its collaboration with New Century Health (NCH) to implement a new prior authorization program.

Who is New Century Health?

NCH is a comprehensive oncology quality management (OQM) and cardiology management specialty company optimizing the application of evidence-based medicine for the delivery of adult ambulatory cancer care and cardiology care.

Beginning July 1, 2023:  The following interventional cardiology services will require a prior authorization from NCH before services are rendered in a physician’s office, outpatient hospital, inpatient hospital (planned/elective services only), or ambulatory setting:

  • Ablation
  • Angiography
  • Aortic Valve Surgery
  • Bypass Graft In-Situ Vein
  • Bypass Graft Vein
  • Cardiac Catheterization
  • Congenital Health Disease Surgery
  • Coronary Artery Disease Surgery
  • Device Implantation/Electrical Cardioversion
  • Device Monitoring
  • Electrophysiology Studies (EPS)
  • Endovascular Interventions
  • Excision, Exploration, Repair, Revision
  • Strippings/Ligations
  • Interventional Cardiology
  • Interventional Radiology
  • Left Atrial Appendage Closure
  • Mitral Valve Surgery
  • Pulmonary Artery Surgery
  • Pulmonary Valve Surgery
  • Repair/Excision for Aneurysm, Occlusive Disease, etc.
  • SAVR
  • TAVR
  • Therapeutic Services
  • Thromboendarterectomy
  • Tricuspid Valve Surgery

*93745- Life Vest Programming (Related to Electrophysiology)

This prior authorization requirement applies to your Wellcare Medicare Advantage members ages 18 and older for the following lines of business: HMO, PPO, PPO-DSNP, DSNP, PFFs, and C-SNP.

We are also offering in-service/NCH portal training sessions via webinar for your prior authorization team. This meeting will take approximately 60 minutes and we will demonstrate how to submit prior authorizations via the NCH portal as well as other available features and tools/resources.


Please reply to me as to which session(s) is best for you and I will send a calendar invite that you can share with your prior authorization team:

Prior Authorization In-Service Sessions: 

  • June 27, 11 – 12 CST
  • June 27, 2-3 CST
  • June 28, 8 – 9 CST
  • June 28, 12-1 CST
  • June 29, 9-10 CST
  • June 29, 1 – 2 CST
  • June 30, 10 – 11 CST

 Action needed:

 PDW Provider Demographic Information: Please complete and return the attached PDW Provider Demographic Information worksheet, as this information will be used to create login credentials to the NCH on-line portal and to load your practice and providers.

  • First Tab – Physician Information
  • Second Tab – Prior Authorization Staff
  • Third Tab – Business Leadership Information

Additionally, please reference the attached FAQ and provider notification letter for details and thank you for your assistance as we work together to assure you and your team are set for success beginning July 1, 2023.

PDW Provider Demographic Information

Healthy Blue Medicaid – Concierge Care

June 14, 2023

Please review the announcement from Healthy Blue Medicaid:

We are excited to share the attached information regarding our new digital care management program, Concierge Care. We are offering this digital, interactive program to all pregnant women. The app is designed to engage with our members and help them navigate the challenges of pregnancy, offering new digital solutions, and a new way to stay connected with us when it is most convenient for them.

Please review the attached documents, which provides greater detailed information surrounding the program and outreach if you have any additional questions.

MOHB-CAID-001138-22-SRS22 CC Hgh Rsk Mtrnty Flier FINAL

MOHB-CD-014902-22-CPN14665 Concierge Cr HRM Bulletin_FINAL