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2021 Global Provider Manual - v4-3

This document outlines prior authorization requirements for elective inpatient and outpatient care covered by Cigna health insurance. For outpatient care under $400, no prior authorization is needed. For elective inpatient or outpatient care over $400, the health care provider must inform Cigna of the treatment and estimated costs at least 4 weeks before the service if all information is complete. Cigna will then send a guarantee of payment within 48 hours. After discharge, the provider sends the invoice and discharge report to Cigna for direct payment based on the guarantee of payment.

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61 views

2021 Global Provider Manual - v4-3

This document outlines prior authorization requirements for elective inpatient and outpatient care covered by Cigna health insurance. For outpatient care under $400, no prior authorization is needed. For elective inpatient or outpatient care over $400, the health care provider must inform Cigna of the treatment and estimated costs at least 4 weeks before the service if all information is complete. Cigna will then send a guarantee of payment within 48 hours. After discharge, the provider sends the invoice and discharge report to Cigna for direct payment based on the guarantee of payment.

Uploaded by

Corporate PA Progress Group
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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PRIOR AUTHORIZATION REQUIREMENTS

OUTPATIENT CARE BELOW ELECTIVE INPATIENT AND OUTPATIENT CARE


$400 USD (or equivalent local currency) OVER $400 USD (or equivalent local currency)
3 BUSINESS DAYS TO
4 WEEKS PRIOR TO SERVICE IF AFTER DISCHARGE
ALL INFORMATION IS COMPLETE

HEALTH CARE
PROVIDER Informs Cigna on the treatment and Sends the invoice to Cigna,
cost estimate, using the Guarantee indicating the full amount and
of Payment request form via the amount paid by the patient
[email protected]. via [email protected].
› To confirm the customer is active and any
QBOK: Sends the discharge report
patient responsibility, check Cigna Envoy® at
[email protected] to Cigna.
www.CignaEnvoy.com.
› Collect any patient responsibility only.
Remaining balance to be charged to
Cigna directly.
CIGNA
› Submit invoice to Cigna Global Health Pays the invoice to the health
Benefits®. Sends a Guarantee of Payment to care provider.
the provider and the patient within Sends a settlement note (a detail
48 hours on request. of the payment) to the patient
and the health care provider.

DIRECT PAYMENT BASED ON DIRECT PAYMENT BASED ON GUARANTEE OF PAYMENT.


VERIFICATION OF BENEFITS.
IN CASE OF EMERGENCY, PLEASE CALL THE APPROPRIATE CIGNA
REGIONAL NUMBER IMMEDIATELY.

5.90.349_EN (0119)

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