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If you have any questions or would like more information about participating in a Cigna health care network, please contact us. Medical technology is continuously evolving; the guidelines undergo a formal review annually, however eviCore reserves the right to change and update the guidelines without prior notice. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna. eviCore supports the work of physicians and others who strive to reduce the overuse of diagnostic tests that are of low value, of no value, or where the risks of a given diagnostic test are greater than the benefits. that insure or administer group HMO, dental HMO, and other products or services in your state). Member Rights Policy |
We'll discuss the salient differences between them to make selection easier - and more accurate - for you: Provider networks Unlike in an HMO plan where you must visit your PCP and maintain one all year-long, you don't have to do that. endobj To find a participating provider, call eviCore at 800.298.4806 or go to Cigna.com > Find a Doctor. Bardy Diagnostics, Inc. dba BDx Solutions, Inc.: Boston Scientific (Preventice Services, LLC): Pacemaker Monitoring Center, Inc. dba Cardiac Monitoring Center: International normalized ratio services and rapid diagnostic test to measure clotting time for patients using blood thinners. Selecting these links will take you away from Cigna.com to another website, which may be a non-Cigna website. Claims questions: 1 (800) 230-6138 | Appeals questions: 1 (800) 511-6943 | Fax: 1 (800) 931-0149Electronic claims may be submitted through: Paper Claims: Cigna Medicare Advantage, PO Box 981706, El Paso, TX 79998Appeals: Cigna Medicare Advantage Appeals, PO Box 188081, Chattanooga, TN 37422Reconsideration Requests: Cigna Medicare Advantage Reconsiderations, PO Box 20002 Nashville, TN 37202, Mail: Cigna Medicare AdvantageAttn: Special Investigations UnitPO Box 20002, Nashville, TN 37202, Email: SpecialInvestigations@Cigna.comAttn: Cigna Medicare Operations. %%EOF
Appeals and Disputes HIPAA Transaction Standards Questions? Cigna may not control the content or links of non-Cigna websites. Details, Applicable law requires a longer filing period, Provider agreement specifically allows for additional time, In Coordination of Benefits situations, timely filing is determined from the processing date indicated on the primary carrier's explanation of benefits (EOB) or explanation of payment (EOP). Thank you for using eviCores website today! These guidelines apply to Cigna Medicare Advantage customers. %PDF-1.6
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cigna commercial provider manual 2021; How to Easily Edit Cigna Billing Manual Form Online. Network Insider Medicare Provider Newsletter, Provider Portal Claimstat Login Arizona Providers Only, www.eviCore.com/Resources/Healthplan/Cigna-Medicare, www.eviCore/com/Provider/Clinical-Guidelines. This website is not intended for residents of New Mexico. Individual and family medical and dental insurance plans are insured by Cigna Health and Life Insurance Company (CHLIC), Cigna HealthCare of Arizona, Inc., Cigna HealthCare of Illinois, Inc., Cigna HealthCare of Georgia, Inc., Cigna HealthCare of North Carolina, Inc., Cigna HealthCare of South Carolina, Inc., and Cigna HealthCare of Texas, Inc. Group health insurance and health benefit plans are insured or administered by CHLIC, Connecticut General Life Insurance Company (CGLIC), or their affiliates (see For additional information about the Modifier 25 - Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service reimbursement policy please watch this brief video. guidelines at-a-glance flyer or visit our updated provider COVID-19 web page at CignaforHCP.com. Keeping Dental Health providers up to date. <> 0
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Provider customer service 1.800.230.6138 Provider website MedicareProviders.Cigna.com Provider manual MedicareProviders.Cigna.com > 2023 Provider Manual ID card examples MedicareProviders.Cigna.com > 2023 Provider Manual > 2023 Customer Identification Cards Provider portal HSConnectOnline.com Help Desk: 1.866.952.7596 Email: HSConnectHelp@ eviCore's clinical guidelines are evidence-based and apply to the following categories of service for individuals with Cigna-administered plans: Computed Tomography (CT) and Computed Tomography Angiography (CTA) Magnetic Resonance Imaging (MRI) and Magnetic Resonance Angiography (MRA) Positron Emission Tomography (PET) Nuclear Cardiology Selecting these links will take you away from Cigna.com to another website, which may be a non-Cigna website. Visit the Provider Portal at HSConnectOnline.com. 0
open positions so continue your job search at Cigna.com/careers, Clinical Information to Establish Medical Necessity, Peripheral Nerve Disorders Imaging Guidelines, Peripheral Vascular Disease Imaging Guidelines, Pediatric Musculoskeletal Imaging Guidelines, Pediatric Peripheral Nerve Disorders Imaging Guidelines, Pediatric Peripheral Vascular Disease Imaging Guidelines, Radiation Oncology Clinical Appeal Documentation Requirements, Bone Metastases - Xofigo Physician Worksheet, Central Nervous System Lymphoma Physician Worksheet, Central Nervous System Neoplasm Physician Worksheet, Extracranial Oligometastases Physician Worksheet, Gastric Stomach Cancer Physician Worksheet, Liver Cancer, Selective Internal Radiation Therapy Physician Worksheet, Non Cancerous Radiation Therapy Physician Worksheet, Non-Hodgkins Lymphoma Physician Worksheet, Non-Small Cell Lung Cancer CDS Online Document, Other Metastases (Non-Bone/Brain) Physician Worksheet, Lung Cancer, Small Cell Physician Worksheet, Prophylactic Cranial Irradiation (PCI) Radiation Therapy Physician Worksheet, Ureter/Urethral Cancer Physician Worksheet, Site of Care: Outpatient Hospital for Select Musculoskeletal Procedures, Interventional Pain Management Quick Reference Guide Guideline, Joint Surgery Quick Reference Guide Guideline, Preface to Comprehensive Musculoskeletal Management Guidelines, Epidural Adhesiolysis (CMM-207) Guideline, Epidural Adhesiolysis (CMM-207) Guideline - Effective 05/31/2023, Epidural Steroid Injections (CMM-200) Guideline, Epidural Steroid Injections (CMM-200) Guideline - Effective 05/31/2023, Facet Joint Injections / Medial Branch Blocks (CMM-201) Guideline, Facet Joint Injections / Medial Branch Blocks (CMM-201) Guideline - Effective 05/31/2023, Hip Replacement/Arthroplasty (CMM-313) Guideline - Effective 05/31/2023, Hip Replacement/Arthroplasty (CMM-313) Guideline, Hip Surgery Arthroscopic and Open Procedures (CMM-314) Guideline, Hip Surgery Arthroscopic and Open Procedures (CMM-314) Guideline - Effective 05/31/2023, Implantable Intrathecal Drug Delivery System (CMM-210) Guideline, Implantable Intrathecal Drug Delivery System (CMM-210) Guideline - Effective 05/31/2023, Knee Replacement Arthroplasty (CMM-311) Guideline - Effective 05/31/2023, Knee Replacement Arthroplasty (CMM-311) Guideline, Knee Surgery: Arthroscopic and Open Procedures (CMM-312) Guideline - Effective 05/31/2023, Knee Surgery: Arthroscopic and Open Procedures (CMM-312) Guideline, Prolotherapy (CMM-204) Guideline - Effective 05/31/2023, Radiofrequency Joint Ablations/Denervations (CMM-208) Guideline - Effective 05/31/2023, Radiofrequency Joint Ablations/Denervations (CMM-208) Guideline, Regional Sympathetic Blocks (CMM-209) Guideline, Regional Sympathetic Blocks (CMM-209) Guideline - Effective 05/31/2023, Sacroiliac Joint Procedures (CMM-203) Guideline, Sacroiliac Joint Procedures (CMM-203) Guideline - Effective 05/31/2023, Shoulder Surgery (CMM 315) Arthroscopic and Open Procedures Guideline - Effective 05/31/2023, Shoulder Surgery (CMM 315) Arthroscopic and Open Procedures Guideline, Shoulder Arthroplasty/ Arthrodesis (CMM-318) Guideline - Effective 05/31/2023, Shoulder Arthroplasty/ Arthrodesis (CMM-318) Guideline, Spinal Cord and Dorsal Root Ganglion Stimulation (CMM-211) Guideline - Effective 05/31/2023, Spinal Cord and Dorsal Root Ganglion Stimulation (CMM-211) Guideline, Gastrointestinal Endoscopic Procedure Esophagogastroduodenoscopy (EGD), Gastrointestinal Endoscopic Procedure Esophagogastroduodenoscopy (EGD) - Effective 06/15/2023, Gastrointestinal Endoscopic Procedure Capsule Endoscopy, Gastrointestinal Endoscopic Procedure Capsule Endoscopy - Effective 06/15/2023, Error
The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna. There are some exceptions to these deadlines. CoverMyMeds: Website: CoverMyMeds.com (Preferred)Call: 1 (877) 813-5595Fax: 1 (866) 845-7267, 2022 Medicare Advantage Drug Formulary: MedicareProviders.Cigna.com > Pharmacy Resources, To evaluate patient eligibility for a patient support program, access our Patient Support Programs: MedicareProviders.Cigna.com > Patient Support Programs. 6T O'@j8*r', ;#Na-16|=i8IO_K$ _v:s+)"{%#YdQA=2A`,?6P~<4?EE`GD*8j 5pg, =dn/G~5i/!,A1R5n12&A{@ &`" _X)Z$K:PQ84H&TiXh|eOJDK E@0Rkg,_c"3?KpmJT. of authorization request(s). If these clinical guidelines are inconsistent with the terms of the individual's specific coverage plan, then the terms of the individual's coverage plan always takes precedence. Copyright 2022 eviCore healthcare. vaccine, please review our . hbbd```b``kd d im "YC'`S`q{4.F wHeg`bdq m#@g l<
Medicare patients' claims must be filed no later than the end of the calendar year following the year in which the services were provided. Additional clinical guidelines may be developed as needed or may be withdrawn from use. Using these recommended billing guidelines and codes will help facilitate proper reimbursement and help to avoid errors and potential reimbursement delays. CHCP - Resources - Medical Reference Guides Commercial Medical Reference Guides Medical Reference Guides Here you'll find reference guides to help make it easier for health care professionals to do business with Cigna. To view or print these files, you must download and install the free Adobe Acrobat Reader. eviCore positions. As a valued user of our website, wed appreciate your feedback to help us improve your website experience. Accidental Injury, Critical Illness, and Hospital Care plans or insurance policies are distributed exclusively by or through operating subsidiaries of Cigna Corporation, are administered by Cigna Health and Life Insurance Company, and are insured by either (i) Cigna Health and Life Insurance Company (Bloomfield, CT); (ii) Life Insurance Company of North America (LINA) (Philadelphia, PA); or (iii) New York Life Group Insurance Company of NY (NYLGICNY) (New York, NY), formerly known as Cigna Life Insurance Company of New York. Reproduction or retransmission of the materials, in whole or in part, in any manner, without the prior written consent of the copyright holder, is a violation of copyright law. eviCore made it easy to complete my primary task online. Annual Utilization Statistics |
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Selecting these links will take you away from CignaforHCP.com. Optum Womens and Childrens Health, LLC: Healthy Connections Home Care Services, Inc.: Compression therapy products for lymphatic and venous disorders, DME, including off the shelf and drop ship to home (i.e., braces, splints, slings, canes, walkers, prefabricated O&P, and knee supports). See the criteria (PDF) Office manual for health care professionals Medicare and commercial manuals 2022 Provider manual for physicians, hospitals and healthcare providers - effective March 15, 2022 2022 Provider manual for physicians, hospitals and healthcare providers - delegation - effective March 15, 2022 2023 Provider manual for physicians, hospitals and healthcare providers - effective March, 1 2023 4810 0 obj
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Watch this presentation to learn more about cultural competence and the important role you play as a provider. These guidelines are not intended to supersede or replace sound medical judgment, but instead should facilitate the identification of the most appropriate imaging procedure given the individual's clinical condition. IMPORTANT: In the coming days, we will be migrating systems for our In general, Medicare does not consider a situation where (a) Medicare processed a claim in accordance with the information on the claim form and consistent with the information in the Medicare's systems of records and; (b) a third party mistakenly paid primary when it alleges that Medicare should have been primary to constitute "good cause" to reopen. hd|(3bECB!_,BM@2sjn&+_C+S3 kg|N0=8fx8P T! Copyright and other intellectual property laws protect these materials. This website is not intended for residents of New Mexico. If you have any questions or would like more information about participating in a Cigna health care network, please contact us. Details. Cultural competency training video. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. All clinical products and services of the LivingWell Health Centers are either provided by or through clinicians contracted with HealthSpring Life & Health Insurance Company, Inc., HealthSpring of Florida, Inc., Bravo Health Mid-Atlantic, Inc., and Bravo Health Pennsylvania, Inc. or employees leased by HS Clinical Services, PC, Bravo Advanced Care Center, PC (PA), Bravo Advanced Care Center, PC (MD) and not by Cigna Corporation. If services are rendered on consecutive days, such as for a hospital confinement, the limit will be counted from the last date of service. This web site uses files in Adobe Acrobat Portable Document Format (PDF). Updates to Cigna's policies and procedures, Announcements of new Cigna electronic tools and services, Clinical, pharmacy, and Medicare Advantage updates. Request a Consultation with a Clinical Peer Reviewer, Check Status Of Existing Prior Authorization, Check Status of Existing Prior Authorization, Computed Tomography (CT) and Computed Tomography Angiography (CTA), Magnetic Resonance Imaging (MRI) and Magnetic Resonance Angiography (MRA), The terms of the applicable coverage plan document in effect on the date of service, Any relevant collateral source materials including clinical guidelines, The specific facts of the particular situation. Coverage determinations in each specific instance require consideration of: eviCore's guidelines are based upon major national and international association and society guidelines and criteria, peer-reviewed literature, major treatises, and input from health plans, practicing academic and community-based physicians. As of February 1, 2021, eviCore healthcare (eviCore) manages home health care, durable medical equipment (DME), and home infusion therapy for Cigna commercial customers. E-Verify and IER Right to Work. An initial determination on a previously adjudicated claim may be reopened for any reason for one year from the date of that determination. hTkSW?%yy$^5%VS&`Zc/JPZi(t45?lM.X Vb!1ZP&V8f[_2r}Iss/ 0S3UU%j9(UTT ( By using this site, you acknowledge that this material is copyrighted and agree to the terms and conditions noted above. Cigna contracts with Medicare to offer Medicare Advantage HMO and PPO plans and Part D Prescription Drug Plans (PDP) in select states, and with select State Medicaid programs. eviCore has a national network of providers who offer these services. Provider manuals You will find guides to support you in providing care, managing your practice and working with us. %PDF-1.5
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Whether you need to stay informed on Cigna policies, want to check out an informative webinar, or are looking for the latest news on Medicare, youll find it here with our newsletters, dedicated to keeping health care providers at the top of their game. Terms of Use |
Delivering medical providers with important news, including: Connecting Behavioral Health Care Providers with recent news. Individual and family medical and dental insurance plans are insured by Cigna Health and Life Insurance Company (CHLIC), Cigna HealthCare of Arizona, Inc., Cigna HealthCare of Illinois, Inc., Cigna HealthCare of Georgia, Inc., Cigna HealthCare of North Carolina, Inc., Cigna HealthCare of South Carolina, Inc., and Cigna HealthCare of Texas, Inc. Group health insurance and health benefit plans are insured or administered by CHLIC, Connecticut General Life Insurance Company (CGLIC), or their affiliates (see we will be implementing changes to evicore.com in the near future. Cigna does not control the linked sites' content or links. Message Here. 2021 when submitted under Cigna commercial medical benefit plans. All insurance policies and group benefit plans contain exclusions and limitations. % Cigna.com no longer supports the browser you are using. HEALTH CARE PROFESSIONALS PROVIDER MANAUL MEDICARE ADVANTAGE PCOMM -2021-1083 8/21 HEALTH CARE PROFESSIONALS PROVIDER MANAUL MEDICARE ADVANTAGE 2021 Return to Table of Contents Page 2of 113 All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation. Selecting these links will take you away from Cigna.com to another website, which may be a non-Cigna website. Durable medical equipment (including orthotics and prosthetics), home health, and home infusion As of February 1, 2021, eviCore healthcare (eviCore) manages home health care, durable medical equipment (DME), and home infusion therapy for Cigna commercial customers. Were still hiring for other 0
They can easily Tailorize through their choices. Beginning Friday, December 18th at 5:00pm EST, you hb``b``Ab,nF )H\g```h i~ a,g}]Ig]7 1fq61` v T ob!!|Fy JC
endobj Selecting these links will take you away from Cigna Medicare Advantage and Medicare Part D Prescription Drug Plan information. Cigna Medicare Advantage Plans . Oscar is an HMO with a Medicare contract. endstream
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<. All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation. Good health and a good doctor/patient relationship begins with understanding your patients' cultural, ethnic, racial and linguistic needs. If you're unable to file a claim right away, please make sure the claim is submitted accordingly. 128 0 obj
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that insure or administer group HMO, dental HMO, and other products or services in your state). Q4: How can eviCore make it easier for you to use this website? Q1: Overall, how satisfied are you with eviCores website? Find PA forms at MedicareProviders.Cigna.com > Forms and Practice Support > Prior Authorization Requirements. To learn more about a program, or request a patient eligibility evaluation, email CignaRefer_Help@Cigna.com. *The Silver&Fit program is provided by American Specialty Health Fitness, Inc., a subsidiary of American Specialty Health Incorporated (ASH). If a claim was timely filed originally, but Cigna requested additional information. Medical and Dental 1 (800) 88CIGNA (882-4462) Behavioral 1 (800) 926-2273 Pharmacy Email us The Cigna Group Information Disclaimer 4828 0 obj
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If a resubmission is not a Cigna request, and is not being submitted as an appeal, the filing limit will apply. Details Apr 14, 2023 Feedback Will open a new window When you have the right tools, you can give your patients the care they deserve. Remember: Your contract with Cigna prohibits balance billing your patient if claims are denied because they were not submitted within the time frame outlined above. endstream
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Please click here to register for an account. You may request precertification through eviCore in the following ways: For additional information, refer to eviCores provider resources website (www.eviCore.com/resources/healthplan/Cigna). These guidelines are written to cover medical conditions as experienced by the majority of individuals. eviCore's clinical guidelines are evidence-based and apply to the following categories of service for individuals with Cigna-administered plans: The terms of an individual's particular coverage plan document [Group Service Agreement (GSA), Evidence of Coverage, Certificate of Coverage, Summary Plan Description (SPD), or similar plan document] may differ significantly from the standard coverage plans upon which these guidelines are based. Provider Manual For information on Oscar's policies and procedures Clinical Guidelines For the A to Z on Oscar's clinical criteria Reimbursement Policies For current state-specific reimbursement policies STAR Resources For general Quality information and improvement guides Contact Us Need help? Clinical decisions, including treatment decisions, are the responsibility of the individual and his/her provider. ??S d\R|I@z t_5bXXSCp@ufjZPd~8 a}a?%Tz#fr]}
)arE1/KP!}2HSY-=7! providers according to plan rules as listed in the online provider manual. Committed to cultural competency. We take on the administrative burden so you can focus on getting patients the care they need, and get paid in a timely manner. wont be able to apply to eviCore openings. Provider Reference Guide - Baylor Scott & White Health Plan endstream
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Helping you keep up with research, trends, and policy changes that impact your practice. eviCore's clinical guidelines may include information inapplicable to benefit plans administered by Cigna. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna. As always, you can appeal denied claims if you feel an appeal is warranted. Accidental Injury, Critical Illness, and Hospital Care plans or insurance policies are distributed exclusively by or through operating subsidiaries of Cigna Corporation, are administered by Cigna Health and Life Insurance Company, and are insured by either (i) Cigna Health and Life Insurance Company (Bloomfield, CT); (ii) Life Insurance Company of North America (LINA) (Philadelphia, PA); or (iii) New York Life Group Insurance Company of NY (NYLGICNY) (New York, NY), formerly known as Cigna Life Insurance Company of New York. For availability, costs and complete details of coverage, contact a licensed agent or Cigna sales representative. On January 1, 2023, eviCore began managing the provider network for orthotics and prosthetics (O&P) services for Cigna commercial customers. Cigna insurance, now, offers both PPO and HMO plans. April 1 - September 30) Cigna Medicare Advantage Plans (Arizona Only) 1 (800) 627-7534 (TTY 711) 8:00 am 8:00 pm Mountain time, 7 days a week that insure or administer group HMO, dental HMO, and other products or services in your state). In addition to the RFI content , Cigna LifeSOURCE annually evaluates each transplant program to determine continued compliance with established guidelines . For availability, costs and complete details of coverage, contact a licensed agent or Cigna sales representative. Alere Home Monitoring, Inc. dba Acelis Connected Health Services: Hearing aids, replacement hearing aid batteries for non-rechargeable hearing aids, charging stations for rechargeable hearing aids, supplies, and personal sound amplification products, Fetal monitoring services, including use of electronic devices to check a babys heartbeat before and during childbirth, electronic fetal monitoring, fetal stress tests, and baby heartbeat monitors. ?siuC~62Ovxy:5igu+aF7c
The website includes several educational materials: frequently asked questions documents, quick reference guides, provider training presentations, DME and O&P precertification form, and lists of Healthcare Common Procedure Coding System codes that require precertification through Cigna. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. All pictures are used for illustrative purposes only. Delivering medical providers with important news, including: Updates to Cigna's policies and procedures Announcements of new Cigna electronic tools and services Clinical, pharmacy, and Medicare Advantage updates Health-related news, trends, and more Read the current issue Behavioral Health: Transformations ka[|Ku@,OK"5HwC8UR10w%oF~O>?q8P y|Qge?6N$i@5@)Q \hRC-$J2RpjnPpS=ud7ofT& *FQQe^ afsTOln7ePX5@bGpF]$J\[R^5s=>nfL4f]_I>-!R|79@[Z6PVpd1*%FW0TCBGWP4|!
This is useful for forms that you want to view and/or print. a listing of the legal entities Cigna may not control the content or links of non-Cigna websites. The services and national providers are outlined below: www.eviCore.com/resources/healthplan/Cigna, Beds, wheelchairs, walkers, scooters, off-the-shelf DME (e.g., braces, splints, slings), and compression (tight-fitting) clothing for all body areas to help post-surgery healing and improve circulation, Prefabricated and fabricated (custom) O&P, postmastectomy supplies (i.e., bras, forms, and compression sleeves), and wigs, Oxygen, continuous positive airway pressure equipment, and ventilators, Anti-infective therapy, total parenteral nutrition, pain management, inotropic therapies, immune globulin, enzyme replacement, and REMICADE, Nursing, therapies, social work, and home health aides, Insulin pumps and supplies, continuous passive motion machines and supplies, wound vacuums and supplies, and breast pumps, Provider contracting, credentialing, and demographic updates, Claims processing for Shared Administration Repricing and Payer Solutions customers, Initial precertification requests (forwards precertification request/information over to Cigna), Claims processing, except for Shared Administration Repricing and Payer Solutions customers, Customer-based services, including benefits, eligibility, and appeals, Provider and customer denial letters for services that are not authorized, Cardiology devices and equipment and heart monitoring equipment and services, including arrhythmia monitors, Holter monitors, and digital and wireless monitoring. General Information: Provider Customer Service: 1 (800) 230-6138 Provider Website: MedicareProviders.Cigna.com Provider Manual: 2022 Provider Manual [PDF] ID Card Examples: 2022 Provider Manual [PDF] > Customer Identification Cards Provider Portal: HSConnectOnline.com Help Desk: 1 (866) 952-7596 Email: HSConnectHelp@HSConnectOnline.com ICD-10 Coding & Documentation/
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