May 2017

Employee Benefit Systems Group Numbers
Employee Benefit Systems is issuing updated member ID cards to the employees of Henry County Health Center and S & J Tube Corporation.

Submitting Medica Claims via Zirmed
Providers who use the clearinghouse Zirmed to submit EDI claims for Medica members should use payer ID Z95382.

Midlands Choice Holiday Office Closings
The Midlands Choice office with be closed in observance of summer holidays.

Secured Website Audit Process
All registered users of the secured tools on the MidlandsChoice.com website are subject to a yearly audit.

Assurant Health Accessibility
Beginning April 1, 2017, the Assurant Health customer service department will no longer be accessible by phone. Questions must be submitted in writing.

Medica May 2017 Provider Newsletter
The May 2017 edition of Medica's provider newsletter, Medica Connections, has been published and is available for viewing.

Medica April 2017 Provider Newsletter
The April 2017 edition of Medica's provider newsletter, Medica Connections, has been published and is available for viewing.

Medica March 2017 Provider Newsletter
The March 2017 edition of Medica's provider newsletter, Medica Connections, has been published and is available for viewing.

HealthPartners May 2017 Provider Newsletter
The May 2017 edition of HealthPartners provider newsletter, Fast Facts, has been published and is available for viewing.

HealthPartners March 2017 Provider Newsletter
The March 2017 edition of HealthPartners provider newsletter, Fast Facts, has been published and is available for viewing.

Cigna April 2017 Provider Newsletter
The April 2017 edition of Cigna's provider newsletter, Network News, has been published and is available for viewing.

February 2017

Resubmitting Corrected Claims
A claim cannot be processed as a "corrected" claim unless it is resubmitted with an indicator to alert the Midlands Choice claim processing system that the claim is a replacement claim.

Medica December 2016 Provider Newsletter
The December 2016 edition of Medica's provider newsletter, Medica Connections, has been published and is available for viewing.

Medica Preventive Medicine and Screening Policy
Effective January 1, 2017, Medica is implementing a Preventive Medicine and Screening policy which addresses reimbursement of preventive medicine services when performed with other evaluation and management (E/M), screening and miscellaneous services.

Illinois Casualty Company
Illinois Casualty Company will be insured through Quad City Community Healthcare c/o Auxiant, a new payer with Midlands Choice, effective January 1, 2017.

Advance Physical Therapy
Employees of Advance Physical Therapy will be insured through HealthLink c/o Current Health Solutions effective January 1, 2017.

HealthPartners January 2017 Provider Newsletter
The January 2017 edition of HealthPartner's provider newsletter, Fast Facts, has been published and is available for viewing.

Medica January 2017 Provider Newsletter
The January 2017 edition of Medica's provider newsletter, Medica Connections, has been published and is available for viewing.

Quincy Medical Group
Employees of Quincy Medical Group are insured through HealthLink c/o CoreSource Inc. effective January 1, 2017.

Medica February 2017 Provider Newsletter
The February 2017 edition of Medica's provider newsletter, Medica Connections, has been published and is available for viewing.

Cigna January 2017 Provider Newsletter
The January 2017 issue of Cigna's provider newsletter, Cigna Network News, is available for viewing.

Provider's Rights during the Credentialing Process
Current and prospective Midlands Choice providers going through the initial or renewal application process have rights granted as an applicant through national credentialing standards.

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

Midlands Choice Call Center Hours
The Midlands Choice customer service call center will be closed for a half an hour each day during the lunch hour. Our new service hours will be 8:00 am to 4:30 pm with a break from 12:00 pm to 12:30 pm.

HealthPartners February 2017 Special Edition Newsletter
HealthPartners has published a special edition of their provider newsletter, Fast Facts, that provides information about the HealthPartners UnityPoint health plan.

HealthPartners and Midlands Choice Partner in Iowa and Nebraska
Effective 1/1/2017 Midlands Choice will be the network option for all HealthPartners members who receive care in Iowa and Nebraska. This previously was administered through Cigna.

November 2016

HealthPartners and Midlands Choice Partner in Iowa and Nebraska
Effective 1/1/2017 Midlands Choice will be the network option for all HealthPartners members who receive care in Iowa and Nebraska. This previously was administered through Cigna.

Midlands Choice Holiday Office Closings
The Midlands Choice office will be closed to observe upcoming holidays.

Submitting Claims for Medica Insure Members
When submitting claims for patient's who are insured through Medica Insure, please remember to use the claim submission information found on the member identification card.

National General Benefits Solutions
National General Benefits Solutions administers the self-funded groups formerly administered by Assurant Health.

Lincoln Electric System
Coverage for the group Lincoln Electric System will be moving from PreferredOne Administrative Services to Auxiant effective January 1, 2017.

Cigna October 2016 Provider Newsletter
The October 2016 issue of Cigna's provider newsletter, Cigna Network News, is available for viewing.

Medica November 2016 Provider Newsletter
The November 2016 edition of Medica's provider newsletter, Medica Connections, has been published and is available for viewing.

Medica October 2016 Provider Newsletter
The October 2016 edition of Medica's provider newsletter, Medica Connections, has been published and is available for viewing.

Medica September 2016 Provider Newsletter
The September 2016 edition of Medica's provider newsletter, Medica Connections, has been published and is available for viewing.

August 2016

Register for Secure Access to MidlandsChoicecom
Since Midlands Choice revamped the MidlandsChoice.com website in July 2015, more than 2650 users have registered for secure access to the site.

Group Information on Claims
Midlands Choice often receives claims with group and payer information that is no longer accurate or for groups that no longer have a relationship with Midlands Choice.

QualChoice Lab Policy Update
Beginning January 1, 2017, QualChoice will no longer reimburse providers who bill for send out lab using modifier 90, per CMS guidelines.

Medica August 2016 Provider Newsletter
The August 2016 edition of Medica's provider newsletter, Medica Connections, has been published and is available for viewing.

Cigna July 2016 Provider Newsletter
The July 2016 issue of Cigna's provider newsletter, Cigna Network News, is available for viewing.

Federated Insurance
Federated Insurance has begun transitioning employer groups from the Midlands Choice network to the UHC Choice Plus network starting July 1, 2016.

City of Charles City
City of Charles City employees in Iowa began to be insured through North Iowa Community Healthcare c/o Auxiant effective July 1, 2016.

Medica July 2016 Provider Newsletter
The July 2016 edition of Medica's provider newsletter, Medica Connections, has been published and is available for viewing.

Medica June 2016 Provider Newsletter
The June 2016 edition of Medica's provider newsletter, Medica Connections, has been published and is available for viewing.

May 2016

Secure Website Audits Underway
Midlands Choice conducts annual audits to ensure that authorized individuals who currently have access to the secure data on MidlandsChoice.com should continue to have access.

Communicate Demographic Updates
All demographic changes for group practices or specific providers must be communicated to Midlands Choice or your contracting entity.

Cigna April 2016 Provider Newsletter
The April 2016 issue of Cigna's provider newsletter, Cigna Network News, is available for viewing.

Medica May 2016 Newsletter
The May 2016 edition of Medica's provider newsletter, Medica Connections, has been published and is available for viewing.

Medica QHP Requirements
The Medica Administrative Manual contains specific Qualified Health Plan (QHP) requirements, including the QHP requirements for Indian Health Care Providers.

Medica April 2016 Newsletter
The April 2016 edition of Medica's provider newsletter, Medica Connections, has been published and is available for viewing.

Buchanan County
Buchanan County employees in Iowa will be insured through Cedar Valley Community Healthcare c/o Auxiant, a new payer with Midlands Choice, effective April 1, 2016.

Medica March 2016 Newsletter
The March 2016 edition of Medica's provider newsletter, Medica Connections, has been published and is available for viewing.

February 2016

A Complete Application is Key to Timely Credentialing
The Midlands Choice credentialing department has shared guidelines to help ensure that credentialing applications are processed in a timely manner.

Provider's Rights During the Credentialing Process
Current and prospective Midlands Choice providers going through the initial or renewal application process have rights granted as an applicant through national credentialing standards.

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

Cigna's DRG Clinical Review Program
Cigna's Diagnosis Related Group (DRG) Clinical Review program evaluates claims data from hospitals that are reimbursed using a DRG payment methodology.

Cigna Changes Coverage for Juxtapid and Kynamro
Starting January 15, 2016, customers with Cigna pharmacy coverage will need to try Repatha.

Cigna Ambulance Services Reimbursement Policy
Effective April 11, 2016, Cigna will update their Ambulance Services Reimbursement Policy (R18) and only reimburse non-emergency ambulance transportation when a hospital is the origin or destination of the service.

Cigna January 2016 Provider Newsletter
The January 2016 issue of Cigna's provider newsletter, Cigna Network News, is available for viewing.

Medica January 2016 Provider Newsletter
The January 2016 edition of Medica's provider newsletter, Medica Connections, has been published and is available for viewing.

Medica February 2016 Provider Newsletter
The February 2016 edition of Medica's provider newsletter, Medica Connections, has been published and is available for viewing.

National General Benefits Solutions
National General Benefits Solutions is a new payer with Midlands Choice.

UnityPoint Health Employer Group
The employer group UnityPoint Health became insured through HealthPartners c/o Cigna effective January 1, 2016.

November 2015

Register for an Account on the New MidlandsChoice.com Website
By registering for a secure account on the recently updated MidlandsChoice.com, users can discover the status of claims, get a copy of the repricing face sheet, find out how to contact payers, look up information for employer groups and more - 24 hours a day, 7 days a week.

Nebraska Furniture Mart
The employer group Nebraska Furniture Mart will be insured through Cigna effective January 1, 2016.

Claim Submission Deadline for CoOportunity Health
Pursuant to the Liquidation Order of the Iowa District Court, all claims for healthcare services provided to CoOportunity Health insureds must be submitted by December 15, 2015.

Nebraska Beef, LTD
Employees of Nebraska Beef LTD began accessing coverage through Meritain Health effective November 1, 2015.

Cigna October 2015 Provider Newsletter
The October 2015 issue of Cigna's provider newsletter, Cigna Network News, is available for viewing. 

Medica Insure Update
Medica, a new payer with Midlands Choice, will begin marketing to potential members in Nebraska and Iowa beginning November 1, 2015. Medica will be offering individual and family business plans both on and off the Nebraska and Iowa Health Insurance Marketplace under the product name "Medica Insure".

MidlandsChoice.com Browser Support
The MidlandsChoice.com website will not be fully supported when accessed through Internet Explorer versions 7, 8 or 9 beginning on January 12, 2016.

September 2015

 ICD-10 Claim Submission Guidelines
Midlands Choice will be compliant in accepting, processing, and transmitting ICD-10 code sets beginning on October 1, 2015.  

Metropolitan Community College
A new group with Midlands Choice, Metropolitan Community College, is effective August 15, 2015 through payer AIG Educational Markets.

CoOportunity Health Claims Submittal Deadline
All claims for healthcare services provided to CoOportunity Health members should be submitted by December 15, 2015. 

Cigna July 2015 Provider Newsletter
The July 2015 issue of Cigna's provider newsletter, Cigna Network News, is available for viewing. 

Register for Access to Secured Tools
Due to the recent updates to MidlandsChoice.com, all past and current users of the website’s secured features must re-register for a secure user account. 

May 2015

Medica to Utilize Midlands Choice Network
Medica, a non-profit health insurance company, will be using the Midlands Choice network for the Medica Insure products.

Provider Operating Manual
Midlands Choice has published an updated Provider Operating Manual.

Cigna April 2015 Provider Newsletter
The April 2015 issue of Cigna's provider newsletter, Cigna Network News, is available for viewing.

Coming Soon: A New Look for MidlandsChoice.com
Midlands Choice is in the process of enhancing the midlandschoice.com website to include improved user capabilities and additional security functionality.

Unverferth Manufacturing Company
Unverferth Manufacturing Company, Inc. employees located in Iowa will be insured with a new Midlands Choice payer, MedBen, effective May 1, 2015.

CoOportunity Health Membership Update
Individual and group members have received notice as to when their CoOportunity Health coverage will terminate.

Cigna's 2015 Preventive Health Coverage Guide
Cigna has published the 2015 version of their Guide to Preventive Health Coverage for health care professionals.

February 2015

Cigna Electronic Precertification Submission eCourse
Cigna has developed a brief eCourse about electronic precertification submission (ANSI 278 transaction).

Group Number and Payer Name on Claims
It is important that the patient’s group number and the name of the payer (not Midlands Choice) be included on each claim submitted.

Cerner HealthPlan Services
Effective January 1, 2015 Cerner HealthPlan Services began accessing the Midlands Choice network. Claims for this group should be sent directly to Cerner HealthPlan Services.

Demographic Updates
All demographic changes for group practices or specific providers must be communicated to Midlands Choice or your contracting entity.

Provider's Rights during the Credentialing Process
Current and prospective Midlands Choice providers going through the initial or renewal application process have rights granted as an applicant through national credentialing standards.

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

Cigna January 2015 Provider Newsletter
The January 2015 issue of Cigna's provider newsletter, Cigna Network News, is available for viewing.

CoOportunity Health Moves Toward Liquidation
The Iowa Insurance Commissioner has determined that efforts to rehabilitate CoOportunity Health have been unsuccessful and he has asked the court to place the company into liquidation.

November 2014

CoOportunity Health October 2014 Provider Alert
The October 2014 edition of CoOportunity Health's Provider Alert is available for viewing.

Cigna Addresses Issues about Compounded Drugs
Cigna has published a flyer that explains issues and concerns associated with compounded drugs and actions that Cigna is making to address these issues.

New Payer for CHI Health Nebraska Employees
Employees of CHI Health Nebraska will begin coverage with Prominence Health dba QualChoice, a new Midlands Choice payer effective January 1, 2015.

Cigna's October 2014 Provider Newsletter
The October 2014 issue of Cigna's provider newsletter, Cigna Network News, is available for viewing.

CoOportunity Health November 2014 Provider Alert
The November 2014 edition of CoOportunity Health's Provider Alert is available for viewing.

CoOportunity Health Withdraws Only from Iowa's Medicaid Expansion Plan
CoOportunity Health is withdrawing from the Iowa Marketplace Choice Plan (IMCP). The last day of coverage for IMCP members with CoOportunity Health will be November 30, 2014.

CoOportunity Health September 2014 Provider Alert
The September 2014 edition of CoOportunity Health's Provider Alert is available for viewing.

August 2014

ICD-10 Frequently Asked Questions
Midlands Choice has published an ICD-10 frequently asked question page on midlandschoice.com, as well our ICD-10 readiness statement.

CoOportunity Health August 2014 Provider Alert
The August 2014 edition of CoOportunity Health's Provider Alert is available for viewing.

CoOportunity Health's Iowa Product Changes for 2015
CoOportunity Health will be offering a new select network product with out-of-network benefits in Iowa in 2015.

Cigna 2014 Preventive Health Guide
A guide to Cigna's preventive health coverage for health care professionals has been updated for 2014.

Cigna Mailing Address Consolidation
Cigna has consolidated all mailing locations for Cigna paper claims and appeals to Chattanooga, TN.

Cigna's July 2014 Provider Newsletter
The July 2014 issue of Cigna's provider newsletter, Cigna Network News, is available for viewing.

CoOportunity Health July 2014 Provider Alert
The July 2014 CoOportunity Health Provider Alert publication is available for viewing.

CoOportunity Health June 2014 Provider Alert
The June 2014 CoOportunity Health Provider Alert publication is available for viewing.

May 2014

Submitting Claims on the 1500 v. 02-12 Form
All paper claims for professional services submitted to Midlands Choice must be on the 1500 version 02-12 claim form, regardless of the date of service on the claim. Claims submitted on outdated versions of the form will be returned, requiring that the claim be resubmitted on the correct version of the form.

Aetna Claim Issues
Aetna no longer uses the Midlands Choice network of providers or contracted pricing. All claim and provider issues must be addressed directly with Aetna.

CoOportunity Health Secure Provider Website
Providers can register for CoOportunity Health's secure provider website at coOportunityhealth.com/provider.

CoOportunity Health Fully- vs. Self-Insured Business
CoOportunity Health has published a fact sheet that details the differences between their fully-insured and self-insured business.

CoOportunity Health May 2014 Provider Alert
The May 2014 CoOportunity Health Provider Alert publication is available for viewing.

Cigna's April 2014 Provider Newsletter
The April 2014 issue of Cigna's provider newsletter, Cigna Network News, is available for viewing.

CoOportunity Health April 2014 Provider Alert
The April 2014 CoOportunity Health Provider Alert publication is available for viewing.

CoOportunity Health March 2014 Provider Alert
The March 2014 CoOportunity Health Provider Alert publication is available for viewing.

February 2014

1500 v. 02-12 Claim Form
Any paper claims for professional services that Midlands Choice receives submitted on the CMS 1500 (08-05) form after March 31, 2014 will be sent back to the provider requiring that the claim be resubmitted on the 1500 (02-12) form.

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

Provider's Rights during the Credentialing Process
Current and prospective Midlands Choice providers going through the initial or renewal application process have rights granted as an applicant through national credentialing standards.

Revstone Castings Fairfield
Claims for members of Revstone Castings Fairfield must be received no later than March 31, 2014 to be considered for reimbursement.

Cigna's Daily Maximum Limit for Injectable Claims
Cigna will begin requesting additional documentation for injectable claims in certain instances starting on February 17, 2014.

Cigna Launches New Code Editing Software
On February 17, 2014, Cigna began using ClaimsXten, a rules-based software application that evaluates claims for adherence to industry-standard coding practices.

CoOportunity Health February 2014 Provider Alert
The February 2014 CoOportunity Health Provider Alert publication is available for viewing.

CoOportunity Health Unique ID Numbers
CoOportunity Health issues a unique member ID number for each family member, regardless of age.

Aetna Network Change
Effective April 1, 2014 Aetna will no longer be using the Midlands Choice network and contracted pricing.

Cigna's January 2014 Provider Newsletter
The January 2014 issue of Cigna's provider newsletter, Cigna Network News, is available for viewing.

Aetna's 2014 Precertification List
Aetna's 2014 precertification list for participating providers has been published.

Bernie Lowe & Associates 411 Plan
Effective January 1, 2014, Midlands Choice established a new payer relationship with Bernie Lowe & Associates, Inc. to use the Midlands Choice network in the administration of benefits for municipalities located in Iowa covered by the Iowa 411 law.

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

November 2013

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

First Administrators, Inc.
The payer First Administrators, Inc. has notified Midlands Choice that they are terminating their relationship with us effective December 31, 2013.

Payer ICD-10 Readiness Survey Results
Midlands Choice recently sent a survey to payers to poll their ICD-10 implementation readiness.

Learn More about CoOportunity Health
More information about CoOportunity Health can be found by visiting their website, www.coOportunityhealth.com/provider.

Cigna's October 2013 Provider Newsletter
The October 2013 issue of Cigna's provider newsletter, Cigna Network News, is available for viewing.

Aetna's Precertification List
Aetna's most recent precertification list for participating providers has been published.

Updated 1500 Claim Form
The National Uniform Claim Committee (NUCC) has announced the approval of the updated 1500 Claim Form that accommodates reporting needs for ICD-10.

Aetna Multiple Procedure Reduction Policy
Effective for dates of service on or after October 1, 2013, Aetna will update their multiple procedure reduction policy, including the reduction percentages for certain therapy procedures.

August 2013

ICD-10 Implementation Project Timeline
As part of Midlands Choice ICD-10 implementation project, a timeline has been created that highlights major milestones.

Introducing CoOportunity Health
CoOportunity Health is Iowa and Nebraska’s first and only not-for-profit CO-OP, a Consumer Operated and Oriented Plan, offering health insurance to individuals and employers. CoOportunity Health members will begin using their products on January 1, 2014.

Gary Busack Named Senior Director of Contracting
Midlands Choice has named Gary Busack senior director of contracting.

Cigna's July 2013 Provider Newsletter
The July 2013 issue of Cigna's provider newsletter, Cigna Network News, is available for viewing.

Aetna Precertification List Update
Aetna is adding several new drug codes to their National Precertification List effective September 1, 2013.

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

Aetna Claim Rework Process Change
Aetna has implemented a process improvement that better positions them to be the front line support for provider claim issues.

May 2013

Updates to Cigna's Qualitative Drug Screen Testing Code Edits
Cigna will be updating their Code Edit Policy with guidelines for Qualitative Drug Screen Testing effective August 19, 2013.

ICD-10 Preparedness
Midlands Choice has compiled a list of some helpful suggestions to keep in mind as your organization works toward ICD-10 compliance.

Credentialing Change for Audiologists and Therapists
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
Effective June 3, 2013, Aetna will no longer mail claim Explanation of Benefits (EOBs) to some providers' offices.

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

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

February 2013

Cigna's January 2013 Provider Newsletter
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
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
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
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).

Cigna Sleep Management Program
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
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.

Claim Submission Guidelines
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.

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

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

November 2012

Midlands Choice Partners with Health Alliance
Midlands Choice has formed a relationship with Health Alliance, a large providerā€sponsored health insurer located in Urbana, Illinois.

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

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

Verifying Benefits through Cigna
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
Cigna has updated their precertification list to reflect HCPCS codes released by The Centers for Medicare & Medicaid Services (CMS) on October 1, 2012.

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

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

Midlands Choice Provider Matching Logic
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
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
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
Beginning in January 2013, Meritain members will have access to the Aetna Choice POS II product.

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

August 2012

Aetna Precertification Updates
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
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
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
Cigna has made changes to the appearance of the Explanation of Payment (EOP) for GWH-Cigna patients’ statements.

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

Cigna Precertification Updates
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.

Aetna Clinical Payment, Coding and Policy Changes
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
Beginning July 1, 2012, Aetna will require precertification for outpatient infusion of several drug classes.

Aetna to Require Accreditation for In-Office Surgical Pathology
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.

Change in GWH-Cigna Claims Submission
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.

May 2012

Aetna to Discontinue Paper EOBs
Effective June 1, 2012, Aetna will no longer mail claim Explanation of Benefits (EOBs) to some providers' offices.

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

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

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

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

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

Product Type on Aetna ID Cards
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
Several Aetna clinical payment, coding and policy changes are effective June 1, 2012.

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