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Cigna's Appeal Process Explained


Main Points

  • Make sure that you have done all of the appropriate due diligence before starting the process.

  • Thoroughly review the form for accuracy once the appeal form has been filled out. You can find a copy of the appeal form here.

  • Send in the form to the appropriate network address since there are two potential addresses.

At one point or another you have likely had to submit an appeal or at the very least been tempted to send in an appeal to an insurance company due to a claim denial. Each insurance company has their own version of an appeal form and process. Cigna has an in-depth and thorough appeal process that requires that you take special care and precaution while going through the process.

We will discuss the process of filling out the form and what you need to do to get the appeal processed.

Before starting the process you will want to make sure that you have done all of the appropriate due diligence before starting the process. Once you have received a denial you will want to do two things:

  • Submit a corrected claim to the claim address on the back of the patient's Cigna ID card

  • Contact Cigna's customer service department at the number on the back of the patient's Cigna ID card if you need further assistance with this process

Once you have submitted a corrected claim then the next step to getting your appeal processed or your claim reversed is to contact Cigna's customer service department at the number on the back of the patient's Cigna ID card to review any adverse determinations or payment reductions.

Typically, this is when the claim is reversed. The customer service representative has the ability to change the initial decision. If they are unable to do so or are advised by the rep then you will need to move on to step 2 of the process.

The next step in the process is to thoroughly review the form for accuracy once the appeal form has been filled out. You can find a copy of the appeal form here. You need to do three things to request a review:

  • Complete the form that is linked in this blog, including why you believe the claim payment is incorrect and should be changed

  • Include a copy of the original claim and the Explanation of Payment or Explanation of Benefits

  • If you are denying based on level of care, medical necessity, or services denied for no authorization you will need to include treatment notes and a narrative describing the situation

Please follow the following steps when completing the form:

  1. Check the box if you are contracted with Cigna and then provide your Tax ID number and NPI number

  2. Check the box Yes that services have been rendered

  3. Then you are going to check the boxes that best describe your appeal. You should use the description used in Explanation of Benefits

  4. Then you are going to fill out the patient demographic section of the form along with the claim details. Be as thorough and precise as possible in this section

  5. Then you will fill out your demographic information section

  6. Once you have all the demographic information completed then you will include a reason for the appeal and what you expect from an outcome of the appeal. Include any and all relevant documentation that would go to prove your argument.

  7. Finally, include your name, today's date, your phone and fax. Once you have done that and have compiled all the relevant documentation you will want to sign the appeal form

Once you are convinced that you have all of the necessary documentation and you have correctly filled out the appeal form, send in the form to the appropriate network address since there are two potential addresses. However, you will want to be careful during this step because there are two addresses that you can send appeal to.

The answer to which address will depend largely on if you have the back of the patient's Cigna ID card. If the back of the patient's ID card indicates Cigna Network then you will send the appeal and supporting documentation to:

Cigna Appeals Unit

PO Box 188011

Chattanooga, TN 37422

BUT if the patient's card indicates GWH - Cigna Network then you will send the appeal and supporting documentation to:

Great West Healthcare

PO Box 668

Kennett, MO 63857

Before you send the documentation and your appeal you will want to make a copy for your records.

Once you have mailed in the appeal you will want to wait 5-7 days before following up with the insurance company. It is a good idea to schedule a calendar reminder to follow up with the insurance company after you have sent it in to ensure that they have received the denial and are processing your request.

Consistently, follow up and if needed get in touch with your Cigna provider area rep to help move along the appeals process.

If you feel that you need further assistance with this process or have any questions that you would like to speak with a PS representative about, feel free to call 734-437-9432 extension 1 or fill out this form to get connected with a representative directly.

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