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Credentialing Change for Audiologists and Therapists
Date Published:
Starting June 1, 2013 Midlands Choice will no longer accept the Audiology-Therapist Add/Term form and all new providers will be required to complete an application that will be processed prior to their network activation.

Aetna to Discontinue Paper EOBs
Date Published:
Effective June 1, 2013, Aetna will no longer mail claim Explanation of Benefits (EOBs) to some providers' offices

Cigna's April 2013 Provider Newsletter
Date Published:
The April 2013 issue of Cigna's provider newsletter, Cigna Network News, is available for viewing.

Aetna's March 2013 Provider Newsletter
Date Published:
The March 2013 issue of Aetna's provider newsletter, Aetna OfficeLink Updates, has been published and is available for viewing.

Cigna's January 2013 Provider Newsletter
Date Published:
The January 2013 issue of Cigna's provider newsletter, Cigna Network News, is available for viewing

Five Simple Ways to Improve Your Claim Acceptance Success Rate
Date Published:
Midlands Choice has compiled some helpful suggestions to assist providers in getting claims to go through the system smoothly and without issue.

Office Site and Medical Records Standards
Date Published:
Midlands Choice maintains standards for both office site and medical records that Midlands Choice network providers are expected to meet.

Providers' Rights during the Credentialing Process
Date Published:
Current and prospective Midlands Choice network providers have rights during the credentialing process that are granted through national credentialing standards such as URAC or the National Committee for Quality Assurance (NCQA).

Claim Submission Guidelines
Date Published:
Assuring that all information submitted on a claim is in the correct location and format not only complies with rules established by the Centers for Medicare and Medicaid Services (CMS), but also promotes prompt claim turnaround time and payment.

CoOportunity Health Funding is Secure
Date Published:
Although funding for future health insurance cooperatives was cut as part of the fiscal cliff agreement signed into law, the 24 health insurance CO-OPs that already have loan agreements, including CoOportunity Health, will not be affected by the new legislation.

Cigna Sleep Management Program
Date Published:
Cigna is offering a Sleep Management Program to their members beginning February 15, 2013 at which time Cigna will also require precertification for all sleep testing services.

ESA Drugs to Require Cigna Precertification
Date Published:
Beginning February 18, 2013 two erythropoiesis-stimulating agents (ESA) will be added to the list of drugs that require precertification for individuals with a Cigna PHS+ medical management model.

Aetna's 2013 Precertification List
Date Published:
The 2013 edition of the Aetna Participating Provider Precertification List has been published.

Aetna's December 2012 Provider Newsletter
Date Published:
The December 2012 issue of Aetna's provider newsletter, Aetna OfficeLink Updates, is available for viewing.

Midlands Choice Partners with Health Alliance
Date Published:
Midlands Choice has formed a relationship with Health Alliance, a large provider‐sponsored health insurer located in Urbana, Illinois.

NPI for Aetna Claims Inquiries and Precertification
Date Published:
The individual provider NPI number should be used for all claims inquiries and precertification requests and inquiries through Aetna.

Aetna EDI Issue
Date Published:
Aetna has processed some electronically submitted claims for participating providers as non-participating.

Wellness Screening for Cigna Members
Date Published:
Starting in December 2012, a new wellness screening program will be available for Cigna patients.

Cigna's CORE Certification
Date Published:
Cigna is making enhancements to the Eligibility and Benefits transaction response in support of CORE rules and guidelines.

Verifying Benefits through Cigna
Date Published:
There are three different ways to verify Cigna members' eligibility and benefits to learn what services are covered and to avoid claim rejections.

Cigna Precertification Changes
Date Published:
Cigna has updated their precertification list to reflect HCPCS codes released by The Centers for Medicare & Medicaid Services (CMS) on October 1, 2012.

Newly Designed CignaforHCP.com Website
Date Published:
Cigna has redesigned the Cigna for Health Care Professionals website.

Cigna Clinical, Reimbursement and Administrative Policies
Date Published:
Cigna has planned medical policy updates scheduled to go into effect October 22.

Midlands Choice Provider Matching Logic
Date Published:
During October 2012, Midlands Choice will implement updates to the logic that is used to match providers to the correct reimbursement terms in order to improve the accuracy of repricing claims.

Aetna Clinical Payment, Coding and Policy Changes
Date Published:
Aetna has made several clinical payment, coding and policy changes, some of which are effective December 1, 2012.

Changes to Aetna's National Precertification List
Date Published:
Additions, modification and deletions are being made to Aetna's National Precertification List, some of which go into effect on January 1, 2013.

Meritain Members to have Access to Additional Aetna Product
Date Published:
Beginning in January, 2013, Meritain members will have access to the Aetna Choice POS II product.

Batch Precert Notification via Aetna EDI Connect
Date Published:
Aetna's direct connect website, EDI Connect, now allows providers to submit batch precertification notifications electronically.

Bomgaars Supply
Date Published:
Effective October 1, only Nebraska employees of Bomgaars Supply will access Midlands Choice through First Administrators.

Aetna Precertification Updates
Date Published:
Aetna's most current precertification list can be found on Aetna's website. Some additions to the list include medications and medical injectables.

Cigna to Require Precertification for Radiation Therapy
Date Published:
Beginning August 1, 2012, Cigna will require precertification for codes listed on the Radiation Therapy Precertification List for participants covered under plans that are administered by Cigna and that require precertification.

NDC Requirement on Cigna Specialty Medication Claims
Date Published:
Beginning September 1, 2012, in addition to the Healthcare Common Procedure Coding System (HCPCS) code for specialty medications, Cigna will require the National Drug Code (NDC) on some claims.

EOP Upgrade for GWH-Cigna
Date Published:
Cigna has made changes to the appearance of the Explanation of Payment (EOP) for GWH-Cigna patients’ statements

New Search Options and Cost Estimator on myCigna.com
Date Published:
The health care professional directory on myCigna.com now contains capabilities for patients to search for doctors, estimate their cost of care and review quality designations of in-network health care professionals.

Cigna’s New Interactive Voice Response System
Date Published:
Cigna is upgrading their interactive voice response (IVR) automated telephone system. The new system will be launched starting in July, 2012.

Cigna Precertification Updates
Date Published:
On August 6, 2012, Cigna is updating their list of CPT and HCPCS codes to include additional codes (including pharmacy codes) that will require precertification.

Behavioral Health Vendor for GWH-Cigna Members
Date Published:
Beginning on May 1, 2012, all Cigna customers with GWH-Cigna cards began accessing Cigna Behavioral Health (CBH) for behavioral benefits.

Aetna Clinical Payment, Coding and Policy Changes
Date Published:
Aetna has made several clinical payment, coding and policy changes, some of which are effective September 1, 2012.

Aetna to Require Precertification for Outpatient Infusion
Date Published:
Beginning July 1, 2012, Aetna will require precertification for outpatient infusion of several drug classes.

Aetna to Require Accreditation for In-Office Surgical Pathology
Date Published:
Effective January 1, 2013, Aetna will require practices offering in-office surgical pathology testing to be certified with Clinical Laboratory Improvement Amendments (CLIA) and one additional entity under CLIA.

Omaha Tribe of Nebraska
Date Published:
Coverage for the group Omaha Tribe of Nebraska has moved from The Benefit Group to HealthSmart Benefit Solutions effective May 1, 2012.

Change in GWH-Cigna Claims Submission
Date Published:
Effective July 1, 2012, all Great-West Healthcare - Cigna (GWH-Cigna) claims with dates of service of July 1 and forward should be submitted directly to GWH-Cigna at the address shown on the member ID card.

Principal Claims and Appeals
Date Published:
Principal claims and appeals should be submitted as soon as possible in order to assure proper adjudication.

New Customer Service Hours
Date Published:
New Midlands Choice customer service hours will go into effect beginning July 2, 2012.

Guide to Cigna ID Cards
Date Published:
The 2012 Quick Guide to Cigna ID Cards has been updated and redesigned.

Medical Record and Office Site Standards
Date Published:
Midlands Choice maintains standards for both office site and medical records that all providers within the Midlands Choice network are expected to meet.

New ICD Deadline Announced
Date Published:
The Centers for Medicare and Medicaid Services (CMS) has announced plans to set the new ICD-10 compliance date at October 1, 2014.

Aetna to Require Preauthorization for Cardiac Implant Devices
Date Published:
Effective June 1, 2012, Aetna will require preauthorization for the insertion, removal and upgrade of non-emergent cardiac implant devices.

Aetna's Electronic Solutions
Date Published:
A variety of electronic transaction options are available for use to registered users through Aetna's secure provider website.

Aetna Utilization Management and Clinical Policy Information
Date Published:
The information found in Aetna's Clinical Policy Bulletins is used by Aetna's Patient Management Staff to determine precertification, inpatient reviews and medical necessity.

Product Type on Aetna ID Cards
Date Published:
The number on Aetna member ID cards should not be used as an indicator of the product type.

Aetna Clinical Payment, Coding and Policy Changes
Date Published:
Several Aetna clinical payment, coding and policy changes are effective June 1, 2012.

Cigna Electronic Claim Submission
Date Published:
Follow these guidelines to assist in submitting electronic claims with attachments and for submitting claims corrected or secondary claims to Cigna.

Cigna Preventive Health Coverage Guide
Date Published:
A Guide to Cigna's Preventive Health Coverage for Health Care Professionals has been updated.

Cigna Medical Policy Updates
Date Published:
Several Cigna reimbursement and administrative policy changes are effective May 21, 2012.

Cigna Updates Intraocular Lens Policy
Date Published:
Beginning May 21, 2012 Cigna will update their Intraocular Lens Coverage policy.

Cigna Electronic Transaction Enhancements
Date Published:
Cigna implemented changes in support of 5010 compliance during the last quarter of 2011, in addition to making some enhancements to several electronic transactions.

New State Laws on Chemotherapy Coverage
Date Published:
A number of states, including Iowa, enacted regulations effective January 1, 2012 that mandate equal coverage of certain chemotherapy drugs.

Cigna Accepts COB Confirmation via Phone
Date Published:
Cigna now accepts confirmation that a patient has no other insurance over the phone.

Single Payer ID for Cigna Claim Submission
Date Published:
Cigna recently consolidated to a single gateway, allowing vendors to route all Cigna claims to one payer ID.

Cigna Clinical Reimbursement and Administrative Policy Updates
Date Published:
Although no new policy updates were made since Cigna's November, 2011 update, all existing Cigna policies can be viewed by visiting the Cigna for Health Care Professionals website.

5010 FAQs
Date Published:
Since the implementation of 5010 on January 1, Midlands Choice has been asked many questions concerning claims submission. Here are the answers to many of those frequently asked questions to help you with the changes.