  |
Delegated Payers
We refer to Aetna, CIGNA and Principal as "delegated payers" because they reprice their own claims. To avoid unnecessary processing delays, claims for patients covered by these plans should be sent directly to the payer, not Midlands Choice.
| Aetna | CIGNA | Principal |
Aetna
Phone: (888) 632-3862
Main Claim Address: (exceptions are noted in product descriptions below)
P.O. Box 981107
El Paso, TX 79998-1107
Submit electronic claims with payer number 60054.
Providers are encouraged to register for secure access to claims and benefit information through Navinet.
Read about Aetna's Provider Appeals Process.
Aetna Affordable Health Choices Product
This product is designed to provide limited major medical benefits for part-time and hourly workers. It is marketed under the Aetna brand, but administration of benefits, claims processing and customer service are handled by Strategic Resource Company (SRC), an Aetna subsidiary.
Patients with coverage through these plans will present identification cards with the words "Aetna Affordable Health Choices PPO" or "Aetna Affordable Health Choices" at the top of the card.
The SRC claim mailing address is SRC, P.O. Box 23759, Columbia, SC, 29224-3759. For electronic claims, use Payer ID 57604.
Affordable Health Choices Sample Card
Aetna National Advantage Program (NAP)
Members with Aetna’s National Advantage Program (NAP) who travel or attend school within the Midlands Choice service area are entitled to in-network benefits. For these members, the NAP logo and a logo for Aetna Health Fund (AHF), Managed Choice (MC), Open Choice (PPO) or Aetna Choice (POS II) will appear on identification cards, but the Midlands Choice logo will not.
NAP Sample Card
Aetna Signature Administrators Product
Aetna Signature Administrators (ASA) is offered in cooperation with third party administrators and the Midlands Choice network. Several TPAs administer the product, including claims payment and customer service, while Aetna provides stop-loss insurance and reprices network claims.
Unique features of the Signature Administrators program include:
- Patient Management: The TPA conducts medical management. Large Case Management, if required, is conducted by Aetna.
- Claims: Send claims to the TPA at the address listed on identification cards. The TPA will forward claims to Aetna for repricing. Aetna then returns repriced claims to the TPA for adjudication and payment. Aetna's claim payment rules apply.
- Explanation of Provider Payment (EPP): EPPs issued by the TPA accompany claims payments to providers.
Telephone numbers for obtaining information about eligibility and benefits, precertification, or if you have questions about claims, are printed on ID cards.
Signature Administrators Sample Card
Aetna Student Health Plans (formerly known as Chickering)
In non-emergency situations, students with Aetna Student Health Plans coverage should seek assistance from the student health center or obtain a referral from the health center to a network provider. Toll-free customer service telephone numbers vary by school and are printed on ID cards. The claim mailing address for Student Health Plans claims is P.O. Box 981106, El Paso, TX, 79998. The address for submitting appeals is P.O. Box 14464, Lexington, KY, 40512.
Aetna Student Health Plans Sample Card
CIGNA
CIGNA telephone numbers and claim mailing addresses vary by group. Submit electronic claims with payer number 62308.
Information available on the non-secure portion of CIGNA's website includes:
- Updates on the relationship between Great-West and CIGNA
- EDI claim submission
- How to submit appeals
- Medical coverage policies
- Reimbursement (EFT, ERA, multiple procedures, overpayments, etc.)
Providers are also encouraged to register for secure access to CIGNA for Health Care Professionals. Tools on this site allow providers to:
- check claim status
- obtain information about eligibility and benefits
- view and submit precertification requests
- claim editing and bundling procedures
CIGNA plan types that include access to the Midlands Choice network are PPO, EPO, OAP (Open Access Plus), OAP In-Network, Choice Fund, Carelink, Fundamental, Starbridge and HealthPartners. As shown on the ID card sample included in this section, the plan type will be identified on the front of the patient's ID card.
Members with the plan types listed above may also have an "Away From Home" logo on the backs of their ID cards. Presence of this logo indicates that the member has in-network access to Midlands Choice providers, whether or not the Midlands Choice logo appears on the card.
Other important information on the backs of ID cards includes:
- customer service telephone numbers
- claim mailing addresses
- precertification telephone numbers and whether precertification is required for inpatient services only, or both inpatient and outpatient services.
CIGNA Sample Card
CIGNA/HealthPartners
HealthPartners, a Minnesota-based health plan, and CIGNA entered into a partnership that was effective January 1, 2008. The partnership gives HealthPartners' groups access to Midlands Choice providers in Iowa, Nebraska and the HealthPartners South Dakota Service Area through CIGNA's national network.
If a patient presents a HealthPartners identification card, send claims to HealthPartners at the address on the card. Contact information for questions about benefits, eligibility, claim status, submitting claims electronically and medical management policies is also listed on the card.
Claims will be repriced according to Midlands Choice rates. Midlands Choice will be identified on Explanations of Benefits (EOBs).
HealthPartners Sample Card
Principal
Phone: (800) 247-4695
Claim Address:
Central Mail Facility
Principal
P.O. Box 39710
Colorado Springs, CO 80949-3910
Submit electronic claims with payer number 61271.
