Payer Solutions
Active Accounts
Updated April 2024
When it comes to providing health benefits for their employees, some employer groups require a high level of customization and flexibility. Therefore, the employer group may choose to align with the capabilities of a combination of third-party administrators (TPAs), business process outsourcers (BPOs), and select health insurers to meet their needs. Cigna Payer Solutions has relationships with select TPAs, BPOs and health insurers that can help the employer group meet their needs. Cigna Payer Solutions provides a breadth of complementary product solutions, including access to our medical network of providers. Some employer groups may also access the Cigna Dental network, pharmacy benefit management, case management, out-of-network savings program, and/or transplant program, as well as stop-loss coverage.
In these relationships, Cigna Payer Solutions:
- Provides access to our network.
- Performs medical management and utilization reviews.
- Re-prices claims according to our contracted rates and claims logic.
- Provides clinical appeals management.
- Provides contract dispute resolution.
TPAs, BPOs, and insurers:
- Maintain eligibility.
- Administer benefits.
- Pay claims for these shared accounts using their own systems and vendors.
Important information: How TPA-administered plans are managed:
- Payers typically manage smaller business groups, and often use vendors to process payments.
- Typically smaller groups use stop loss coverage at a much higher rate to fund claims.
- These scenarios add to the time it takes to get the explanation of payment (EOP) to you. Standard turnaround time is 30-45 days..
- We require TPAs, BPOs, and insurers to provide eligibility information. This can help minimize late identification of non-covered individuals.
- Plan designs generally require in-network and out-of-network benefit differentials to encourage plan participants to use health care providers who participate in our network.
- We complete a business review to ensure payers meet established standards for claim payment accuracy, payment response time, and customer call statistics (e.g., speed of answer). Adherence to these standards is contractually required and audited on a regular basis.
- Our staff and provider service partners support health care providers and resolve claim inquiries or issues.
- We administer the contractual relationship with health care providers to resolve contract language and intent differences.
Additional Information
- ID cards:
- Contain the Cigna logo and the letter "S" on the front of the card. This designates that Cigna shares the administration of the plan with a third party.
- Include the paper and electronic claims submission addresses.
- Include the TPA or insurer's telephone number and address(es) for inquiries about eligibility, benefits, claim status, and payment. Please contact the TPA with questions about these topics.
- Cigna medical utilization management: includes precertification, concurrent care review, and discharge planning.
- The Payer Solutions Active Accounts list, updated in April 2024, begins on the next page.