What is the behavioral network?

What is the medical network and governing medical contract for reimbursement?

• In MI, Priority Health contractual terms and reimbursement apply. Cigna national ancillary agreements in place will supersede for Cigna customers.
• In all other states, Cigna's contractual terms and reimbursement apply

How will this Strategic Alliance affect my Cigna contract in Michigan's Lower Peninsula?

On January 1, 2021, your current patients with Cigna plans will begin to access in-network medical care through the Priority Health network. If you are contracted with Priority Health before this date, your care will continue to be considered in network for these patients. Otherwise, your care will be considered out of network. Your Cigna agreement will be suspended effective January 1, 2021.

Who should I contact to confirm if I have a contract with Priority Health?

To confirm if you have a contract with Priority Health, go to the Priority Health website (PriorityHealth.com) > Member > Getting Care > Find a Doctor > Skip login. Enter your location and conduct a search. If you participate in the Priority Health network, your name will appear. You may also obtain this information by calling Priority Health Customer Service at 800.942.4765.

Who should I contact to initiate contracting with Priority Health?

Go to PriorityHealth.com > Provider > Join our networks.

Which networks can my patients access starting January 1, 2021?

Your patients with Cigna ID cards will be able to access all providers in Cigna's nationwide network for in-network care. When they live in or travel to Michigan, they will be able to access in-network care through providers who participate in the Priority Health preferred provider organization (PPO) network. Your patients who have Priority Health ID cards will be able to access all providers who participate in the Priority Health network for in-network care. When they live or travel outside of Michigan, they will be able to access in-network care through providers who participate in the Cigna Open Access Plus® (OAP) Network.

How will this new Strategic Alliance affect my reimbursement?

Submit claims as instructed on the patient's ID card. If you are contracted with Priority Health, your claims will be processed and paid at Priority Health-contracted rates. Otherwise, your claims will be processed and paid according to the terms of your patient's benefit plan for out-of-network care.

Who will provide the network for the Upper Peninsula starting January 1, 2021?

Upper Peninsula Health Plan (UPHP) will continue to provide the network for the Upper Peninsula region in Michigan. Cigna and Priority Health have separate agreements with UPHP. Each access their own agreement with UPHP for their members.

How do I confirm eligibility and benefits for patients?

Which of my patients will be impacted by Cigna's new Strategic Alliance with Priority Health?

This Strategic Alliance will impact your patients who have employer-sponsored Cigna plan coverage. There's no change for your patients with Medicare or Medicaid.

Where do I submit claims?

Who processes claims and issues the explanation of payment, explanation of benefits, or statement of account?

When Cigna is the primary plan administrator, Cigna will process the claims and issue the explanation of payment, explanation of benefits, or statement of account.

When Priority Health is the primary plan administrator, Priority Health will process the claims and issue the explanation of payment, explanation of benefits, or statement of account.

How can I review claim status?

What is the address to submit an appeal?

Who do I contact for precertification requests or medical management services (including medical benefit drugs)?

Who do I contact for high-tech imaging services, including precertifications requests?