SHARED ADMINISTRATION REPRICING ACTIVE ACCOUNTS

Transcription

1 SHARED ADMINISTRATION REPRICING ACTIVE ACCOUNTS For Providers January 2018 We provide services to individuals covered by Taft-Hartley trusts and Federal Health (FEHB) plan as part of our shared administration re-pricing (SAR) program for self-funded administrative services only (ASO) benefit plans. For these relationships, we provide access to our network, perform medical management and utilization review, re-price claims according to our contracted rates and claims logic, provide clinical appeals management, and handle contract dispute resolution. For some plans, we may also provide stop-loss insurance, disease management services, pharmacy benefits, or behavioral health benefits. Third-party administrators (s) and self-administered plans maintain eligibility, administer benefits, and pay claims for these shared accounts on their own systems. Following is some additional information about how these plans are managed: We require our partners to frequently provide eligibility information to help ensure early identification of non-covered individuals. Plans require in-network and out-of-network benefit differentials to encourage individuals to use participating providers. We complete a pre-contract checklist to ensure a meets our standards on claim payment accuracy, payment response time, and call statistics (e.g., speed of response). Adherence to these standards is contractually required. We audit s on a regular basis to ensure contract standard compliance and monitor service through random call testing. We retain the relationship with participating providers to resolve contract language and interpretation issues. Our staff and Provider Service and Engagement team support providers and resolve claim inquiries or issues. For appeals, reimbursement issues, and general questions, please call the dedicated Shared Administration Re-pricing provider service telephone at , available between 8:00 a.m. and 6:00 p.m. (EST). Please contact the directly to enroll in electronic remittance advice (ERA) and electronic funds transfer (EFT). ID Cards: ID cards display the Cigna logo and include submission information for paper and electronic claims. The ID card also includes the Cigna telephone to request precertification, as well the s contact information for checking eligibility, benefits, and claim status. Sample Shared Administration ID cards are available in the Quick Guide to Cigna ID Cards, available on the Cigna for Health Care Professionals website (CignaforHCP.com). Medical management: Cigna Health Management, Inc./CareAllies provides medical management for inpatient utilization reviews (precertification) for acute, rehabilitation, and skilled nursing, as well as case management. A review of outpatient services (e.g., home health care, home infusion, spinal procedures) may also be purchased. THN Cigna. Some content provided under license. Page 1 of 6

2 Eligibility, benefits, claim status, and payment: For questions about eligibility, coverage, benefits, or claim status and payment, please contact the at the telephone and address on the member s Cigna ID card. Note: This list was updated in January Name of fund Abatement Workers Local 207 American Postal Workers Union (APWU) Asbestos Workers Local 42 Atlantic Coast Health Plan Bakers Union and FELRA Health and BMWE Chicago Painters & Dec. (cancelled 1/1/2018) BeneSys Carday Associates Associated, LLC telephone for eligibility, benefits, and claims APWU (2798) Colorado Finishing Trades Health and Colorado Laborers Eighth District IBEW (Electricians) Intermountain Ironworkers Health & Welfare Trust IBEW Local No. 1 (effective 7/1/2017) IBEW Local 480 Health & Welfare Plan CompuSys CompuSys CompuSys CompuSys American , or Corporation IBEW Local IBEW Western Utilities BeneSys International Medical Plan (Formerly ACE Insurance THN Cigna. Some content provided under license. Page 2 of 6

3 Iron Workers 167 Iron Workers District Council of Tennessee (effective 1/1/2018) Joint Council Teamsters #3 Southern telephone for Kentucky Laborers Self-administered Laborers and Southwest Service Operating Engineers Local 485 Health & Carday Associates Louisiana Electric Health and Wealth and Louisiana Iron Workers Welfare (623) Masters, Mates & Pilots (MM&P) Memphis Construction Self-administered MO-KAN Ironworkers Wilson-McShane Allied Workers Union Local AEGIS Asbestos Carday Associates Association of Letter Carriers (NALC) Roofers Health New Orleans Electrical Health Operating Engineers Local 474 Health and Operating Engineers of Colorado Pirelli Armstrong Self-administered Wilson-McShane THN Cigna. Some content provided under license. Page 3 of 6

4 Pipefitters Local 123 Pipefitters Local 295 Pipefitters Local 421 Plumbers & Pipefitters Local 553 Pipefitters Local Union 630 Health and Pipefitters LU 803 (Orlando) Railroad Maintenance and Industrial Regional Transportation District/Amalgamated Trans Union Local 1001 Health and Retail Stores Health & Welfare Trust (cancelled 12/31/2017) Retiree s Welfare Trust Roofers Local 49 SAMBA Seafarers Sheet Metal #4 Core Management Resources, Inc telephone for , or J.W. Terrill , or CompuSys Jensen Administrative Services, Inc. Northwest William C. Earhart Co., Inc THN Cigna. Some content provided under license. Page 4 of 6

5 Sheet Metal International Staff Plan Sheet Metal Health Sheet Metal No (effective 9/1/2017) Local 15 Medical Local 49 Family Health Plan Local 100 of North Carolina Health South Central UFCW Southeastern Iron Workers Health Care Plan Southern Operators Health (cancelled 9/1/2017) Southeastern Carpenters and Millwrights Health Trust (cancelled 8/1/2017) South Central Regional Laborers Health and St. Louis Graphic Arts Joint Health and Teamsters 115 Teamsters Local 639 (IBT 639) Tennessee Valley IUOE (Operating Engineers) W C Earhart Southwest Service WC Earhart UFCW Unions and Employers s Administration, LLC telephone for J. W. Terrill Carday or THN Cigna. Some content provided under license. Page 5 of 6

6 U.A. Local 614 Welfare Trustees UFCW 371 Amalgamated Welfare Trust UFCW Allied Trades (CA) UFCW and Employers Arizona H & W Trust UFCW and Employers Kansas and Missouri Trust UFCW 1459 UFCW Local 919 H&W (effective 1/1/2018) UFCW Local 1529 & Employers H&W Plans Union Trowel Trades Ben Central PA Warehouse s Local 730 Health and The Maxon Company Southwest Service S&S HealthCare ACST, Inc telephone for or or or Benesys Associated, LLC THN Cigna. Some content provided under license. Page 6 of 6