Complex Claim Review
Cigna routinely evaluates claims for coding, billing accuracy, and appropriateness.* In these reviews, we look at applicable coverage and reimbursement policies, as well as your patient’s benefit plan, and we review utilization of services and items, such as supplies, durable medical equipment and implants. As a part of the review, we may request supporting claim payment information, such as itemized bills and medical records – for example, operative and procedure reports, implant logs, histories and physicals, office notes, laboratory and radiology reports, or other documents.
| What to submit | Instances when supporting documentation is required |
|---|---|
| Itemized bill+ only |
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| Itemized bill and medical records++ |
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| + An itemized bill sorted by revenue code will expedite the claim review. ++ In some instances, we may request other supporting documentation in addition to the itemized bill. Medical records and itemized bills may be required to support claim reviews for other programs. Example: Medical necessity reviews. |
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Send documentation to expedite processing
Please send requested documentation to our dedicated mailing address or fax number:
Cigna
Complex Claim Review
PO Box 188015
Chattanooga, TN 37422
Fax: 1.859.410.2421
Once we complete our review, we will process and reimburse the claim accordingly, and issue an explanation of payment. We will also send you a letter explaining any charges determined to be not payable, the supporting rationale, and appeal information. Not-Payable Reason Codes list includes descriptions and reconsideration criteria.
For more information about our clinical reimbursement policies and payment policies, visit Reimbursement and Payment Policies, or call us at 1.800.88Cigna (882.4462).
* Effective dates:
Medical - December 1, 2009
Behavioral - October 19, 2015