Navigating The Cigna Claims Process: A Guide To Submitting Bills For Swift Reimbursement

Cigna is a health insurance company that offers a range of services, including medical, dental, pharmacy, and behavioural benefits. The process of submitting a claim to Cigna can vary depending on the type of claim and the specific plan held by the individual. However, there are some general steps that can be followed. Firstly, it is important to activate a myCigna account to access all plan details and live support. This can be done by visiting the Cigna website and following the instructions provided. Once the account is activated, the relevant claim form can be downloaded and printed. This form should then be completed, following the included instructions, and mailed to the address provided. For supplemental health claims, an online claim can be submitted, or a paper form can be filled out and submitted via email, fax, or mail. It is recommended to file a claim as soon as possible to facilitate prompt payment. Additionally, Cigna offers Electronic Data Interchange (EDI) as a way for healthcare providers to submit claims easily.

Understanding the claims process

A claim is a request for payment, similar to a bill. If you have recently received care, you or your doctor will submit or "file" a claim. In most cases, if you received in-network care, your provider will file a claim for you.

When Cigna receives a claim, it is checked against your plan to make sure the services are covered. Once approved, Cigna will pay the healthcare provider or reimburse you, depending on who submitted the claim. Any remaining charges that weren't covered by your plan will be billed to you directly by your provider.

In some cases, you will need to have a procedure, medication, or location pre-approved by Cigna before receiving care; otherwise, the claim may be denied. This is known as prior authorization.

If you purchased coverage on your own through a state or federal marketplace, the plan may require that you see providers in the plan's network; the claim may be denied for out-of-network services.

When a claim is approved, Cigna either pays the healthcare provider directly or you do, depending on who submitted the claim. In most cases, for in-network care, providers will submit claims for you, and you will receive an Explanation of Benefits (EOB).

Your EOB is not a bill but an explanation of how your claim was paid. The provider will bill you directly for any amounts you owe them under your plan.

You can activate your myCigna account to view, manage, or submit a claim.

How to submit a claim

To submit a medical, dental, or mental health claim:

• Download and print the appropriate claim form (depending on the type of claim)
• Follow the instructions included on the form to complete it
• Mail your completed claim to the address shown on the form

To submit a supplemental health claim:

• Submit an online claim if you have a Hospital Indemnity, Cancer Treatment, Lump Sum Heart Attack and Stroke, or Whole Life Insurance plan
• If you prefer to fill out a paper form, visit SuppHealthClaims.com to download a claim form
• Submit completed paper supplemental claims using one of these options:

• Email: [email protected]
• Fax: 1 (860) 730-6460
• Mail: Cigna Healthcare Phoenix Claim Services PO Box 55290 Phoenix, AZ 85078

Submitting a claim

Medical, Dental, or Mental Health Claim

• Download and print the appropriate claim form.
• Follow the instructions included on the form to complete it.
• Mail your completed claim to the address shown on the form.

Supplemental Health Claim

You can submit a supplemental health claim online, or by filling out a paper form. If you choose to fill out a paper form, you can submit it by:

• Email: [email protected]
• Fax: 1 (860) 730-6460
• Mail: Cigna Healthcare Phoenix Claim Services PO Box 55290 Phoenix, AZ 85078

Electronic Funds Transfer (EFT)

You can also enroll in EFT, which transfers claim fee-for-service and capitated payments directly into your bank account. To enroll in EFT:

• Log in to CignaforHCP.com.
• Select "Working with Cigna".
• Select "Enroll in Electronic Funds Transfer (EFT) Options".
• Complete the electronic enrollment form.
• Cigna will then send a "pre-note" transaction to your bank to verify your banking information. If the pre-note is not returned to Cigna, you will begin receiving EFT on your next payment cycle. If it is returned with errors, Cigna will contact you to obtain the correct banking information.

Direct payment options

• Log in to your personal webpages and search for your preferred provider in the Provider List section. If your provider is not listed, contact Cigna and they will attempt to arrange direct payment on a case-by-case basis.
• Go to the Contact page and click "Request a guarantee of payment". Fill in all the necessary information and send the form to Cigna. In urgent cases, members should call Cigna directly. It is important to include as many details as possible when requesting a guarantee of payment, including diagnosis, planned treatment, and estimated costs. Any relevant medical reports or prescriptions should also be included.
• Cigna will send a Guarantee of Payment (GOP) to both the member and the provider within 48 hours. This document will outline whether the treatment is covered and what portion of the expenses will be directly invoiced to Cigna.
• Upon admission, members must show their membership card and the Guarantee of Payment to the provider.
• Cigna will settle the bill directly with the provider. The member will only be responsible for paying the remaining patient portion. After the settlement, the member will receive a settlement note.

Claim denials

Cigna may deny your claim for a number of reasons. If your claim is denied, Cigna will notify you in writing about your appeal rights.

To avoid claim denials, you can:

• Pay your monthly premium on time
• Present your current ID card when you receive services
• Stay in-network, if required by the plan
• Get prior authorization, if required by the plan

If your claim is denied, you can appeal the decision. Before beginning the appeals process, call Cigna Healthcare Customer Service at 1-800-88Cigna (882-4462) to try to resolve the issue. Many issues, including denials related to timely filing, incomplete claim submissions, and contract and fee schedule disputes may be quickly resolved through a real-time adjustment by providing requested or additional information.

If your claim is denied because the service was not pre-approved by Cigna, you can request a binding external review through the Billing Dispute Administrator. Following the internal Cigna Healthcare process, arbitration may be used as a final resolution step.

Claim appeals

Cigna Healthcare has a three-step process to appeal or request a review of coverage decisions.

Step 1: Contact Customer Service

Call the number on your ID card to explain your situation and why you believe the initial decision should be reconsidered. If customer service is unable to resolve your concern, ask the representative how to appeal.

Step 2: Submit an Appeal

If you are not satisfied with the response from customer service, Cigna will provide information on other options that may be available. You can submit an appeal by going to the Customer Forms or, if you are a myCigna user, by logging in to myCigna and going to the Forms Center.

Step 3: Independent External Review

If you are still not satisfied following the completion of the internal appeals process, you or your representative may have the option to submit the dispute for resolution by an independent external reviewer for appeals that involve medical judgment. This option is available for appeals that involve coverage decisions based on issues of medical necessity or experimental treatment. If external review is available to you, you will be provided with instructions on how to request this review after the final internal appeal. The decision of the external reviewer is binding upon Cigna Healthcare or your employer, but not upon you.

Frequently asked questions