CareCentrix expands hours for responding to dedicated email for escalated issues
CareCentrix is our exclusive national ancillary provider of durable medical equipment (DME), home health care, home infusion therapy, and sleep management services for our customers in all markets.Effective November 26, 2016, CareCentrix expanded weekend and after-hours coverage for escalated service issues, now offering support 24/7. The CareCentrix Client Service team will respond to emailed escalations submitted to on weekends from 8:00 a.m. to 6:00 p.m. (EST). You will receive an email acknowledgment and updates will be made every four hours or as requested.The CareCentrix intake telephone line (1.877.466.0164) is available 24/7 for weekend and after-hours escalated service issues. Select option 4 and then 1. Please wait for the prompt to leave a voice message and a CareCentrix representative will promptly return your call.
Enhanced Specialty Care Options program update
The Enhanced Specialty Care Options program, which launched October 24, 2016, is being phased in by affected medication, beginning with Remicade. We are communicating to affected customers, providers, and facilities on a rolling basis 90 days in advance of their current prior authorization date of renewal. The fifth set of Remicade letters will be sent to providers and facilities on December 7, 2016. The program reviews site of care for targeted specialty medications as part of the prior authorization process.A Special Communication Update on the Enhanced Specialty Care Options program was sent on July 25, 2016.
Pharmacy drug list changes: Provider reminder for preferred growth hormone medication
As part of our pharmacy drug list update, Humatrope® will be the only preferred growth hormone medication we will cover, effective January 1, 2017. We will send a letter to affected providers the week of December 5, 2016, to remind them about this change.Information about pharmacy drug lists changes was included in the September 28, 2016, Communication Update.
Strategic Alliance quick reference guide for providers
In December 2016, we updated the quick reference guide (flyer) to highlight key information about customers with medical benefit plans through our strategic alliances.
The flyer includes sample ID cards to help providers easily identify customers with benefit plans offered through our strategic alliances, which includes Tufts Health Plan, HealthPartners, Health Alliance Plan (HAP), and MVP Health Care. The ID cards display our name and the name of the strategic alliance. Providers should submit claims directly to the strategic alliance identified on the customer’s ID card. The alliance will process and pay claims.
Providers should treat patients with strategic alliance plans the same as patients with other Cigna plans. They are covered under the provider’s agreement. Customers must use participating providers in the network aligned with their alliance plan when they are in the alliance service area. However, they can use any participating provider when traveling, or if they live outside of the alliance service area.A copy of the flyer is available, and is attached. An article about our strategic alliances, which will include a link to the flyer, will be included in the January 2017 Network News.
Walgreens retail health clinics sold to Advocate Health Care in Chicago, Illinois
Earlier this year, Walgreens sold 56 of their retail health clinics (Healthcare Clinics, formerly TakeCare Clinics) in the Chicago, Illinois area to Advocate Health Care. Effective May 18, 2016, these clinics, which are owned and operated by Advocate, were rebranded as “Advocate Clinic at Walgreens.” Because customers receiving health and wellness services from a Walgreens location will be seeing an Advocate Health Care provider, they may see a change in billed charges that results in higher out-of-pocket costs compared to services they may have previously received in a Walgreens location. Additionally, customers may also experience higher out-of-pocket costs because Advocate Health Care clinics do not participate in all of our networks, including the LocalPlus® and Cigna Connect networks in the Illinois market.hile there should be no major effect on other providers in our network, neighboring participating retail health clinics may see an increased number of Cigna customers.
Integrated Oncology Management Program: eviCore healthcare precertification requirement
Effective February 20, 2017, providers will be required to request precertification for affected medical oncology medications (including primary chemotherapy and supportive drugs) through eviCore healthcare as part of our Integrated Oncology Management Program. EviCore will review each patient’s treatment plan to ensure it is consistent with National Comprehensive Cancer Network (NCCN)® practice guidelines in oncology. Beginning July 1, 2017, we will expand the Integrated Oncology Management Program to include precertification for specialty pharmacy oncology (oral) medications.
Provider communications:
A sample letter is attached, which can be used in discussions with providers inquiring about this change. Letters were sent on November 22, 2016, to providers who have submitted a claim for these services over the past 12 months, including specialists that may be affected by this program (e.g. oncologists, hematologists, and gynecologic oncologists.)
While Cigna does not normally send notifications directly to Third Party Vendor contracted providers, some of your contracted providers were inadvertently included in the mailing. Please refer to the attached listing of providers who were included in the mailing.