MEDICARE ADVANTAGE QUICK REFERENCE GUIDE

MEDICARE ADVANTAGE QUICK REFERENCE GUIDE | Arizona

For Plan Year 2023

Health Maintenance Organization (HMO)

Preferred Provider Organization (PPO)

Website Customer service

Providers visit: MedicareProviders.az-region Patients visit:

Providers visit: MedicareProviders. Patients visit:

Representatives are available to assist with provider eligibility and resources, benefits information, claims, appeals, PCP change requests (if applicable), and patient engagement

Providers and patients call: 1.800.627.7534

Providers call: 1.800.230.6138 Patients call: 1.800.668.3813

Eligibility verification All participating providers are responsible for verifying a patient's eligibility at each and every visit.

Claims processing Payment disputes are disagreements in the amount allowed or paid on a claim or service and do not require medical records. For an appeal of a denied claim/service, only the following need to be included: 1-Admin notes, 2-ER notes, 3-Consultation notes, 4-Ops notes, 5-Radiology results, if any, 6-Discharge notes (not the notes the patients receive). Please do not send any other notes. Additional paperwork may further delay a response.

Ask to see the patient's ID card. Noted on the ID card along with the patient's identification number are the plan code, name of PCP (HMO only), copayment and effective date. Since changes do occur with eligibility, the card alone does not guarantee the patient is eligible.

> Call: 1.800.627.7534, Monday ? Friday, 8 a.m. ? 5 p.m. > Use ClaimStat: > Pursue additional proof of identification. Each PCP office

is provided with a monthly eligibility roster upon request, which lists new and current Cigna patients with their effective dates. Please be sure to refer to the most current month's eligibility roster.

> Call: 1.800.230.6138

> For questions and claim status, call customer service:

1.800.627.7534

> Use Payor ID 62308 when submitting electronic claims > Paper claims: Cigna Medicare Advantage, P.O. Box 38639,

Phoenix, AZ 85069

> Post-Service Appeals: Cigna Medicare Advantage Appeals,

P.O. Box 188085, Chattanooga, TN 37422

Fax: 1.855.699.8985

> Payment disputes: Cigna Medicare Services Provider

Payment Disputes, P.O. Box 38639, Phoenix, AZ 85069-8639

> Payment disputes fax: 1.860.731.3463

> For questions and claim status, call customer service:

1.800.230.6138

> Use Payor ID 52192 for PPO ONLY when submitting electronic claims

> Paper claims: Cigna Medicare Advantage, PO Box 981706,

El Paso, TX 79998

> Post-Service Appeals: Cigna Medicare Advantage Appeals,

P.O. Box 188085, Chattanooga, TN 37422

Fax: 1.855.699.8985 R D C U N MU A L H ON T I G C M_ A E LD _ N T I SRDCUNMA S T Y D E MUALHOT E _ P Q ANTIGCMEQN9_P_ A E L_U0IDND_NTIS2NMD8UASTYDEM0OBI3PMTE_PQA2EG0PBEQN9_P20R16OE_U0IDN0C1R2NMD8U90A/D0OBI3PM20RA2EG0PB103D20R16OE010C1R13090A/D3020RA:13103D3-10110130:012305:1383-110:01258

,H784,9H-7083449-034

> Payment disputes: Cigna Medicare Advantage Reconsiderations,

PO Box 20002, Nashville, TN 37202

> Payment disputes fax: 1.615.401.4642

PO Box 20012 Nashville, TN 37202

PO Box 20012 Nashville, TN 37202

>000031 9083261 003130 H7849-034 MAPD PPO DA 793 Great Circle Rd Attn: Vicki Hinkes Nashville>00T0N033175920183261 003130 H7849-034 MAPD PPO DA 793 Great Circle Rd Attn: Vicki Hinkes Nashville TN 37521

Online portal for claims and eligibility verification Use ClaimStat: Call: 1.855.944.3037, option 4 For after hours: 1.855.944.3037, option 7

2023 A2Z02ME3mAAIZDaMiClaA: rSdIDuPCrpoaropdfsoPrroto@fs

Sample ID card

4010MR 4- 0C1ig0nMaRPr-eCfiegrnraedPrMefeedrirceadreM(HedMicOa)re (HMO)

Customers' ID cards may look different based on the specific plan.

03130 9083261 0000 0000031 0000031 263 115 03130 9083261 0000 0000031 0000031 263 115

Coming soon

Cigna True ChCoigicneaMTerudeicaCrheoice Medicare

(PPO)

(PPO)

Name

NamH7e849-034 MAHP7D84P9P-0O3D4 AMAPD PPO DA

H7849-034 H7849-034

ID

ID 20000294 20000294

Health Plan Hea(8lt0h84P0la)n (80840)

Issue Date Iss0u1e/0D1a/2te023 01/01/2023

No PCP RequNiroedPCP Required No Referral RNeqouRireefderral Required

RxBIN 01701R0 xBIN 017010 RxPCN CIMCARRxEPCN CIMCARE RxGRP CGMARPxDGRRXP CGMAPDRX

PCP

PC$P0 or $40 $0 orS$p4e0cialist Sp$e3c5iaolirst$55 $35 or $55

Emergency Em$e1r1g0ency $110 Urgent Care Urg$e5n0t Care $50

This card doesThniostcgauradrdanoteesencootvgeuragraenoter epacyomveernatg. e or payment.

Services may rSeqeurvirieceasnmaauythroerqizuairteionanbyauththeoHrizeatlitohnPblaynt.he Health Plan. Medicare limitinMgecdhicaargreeslimapitpinlyg.charges apply. Customer SCeurvsitcoeme1r-S8e0r0v-6ic6e8-318-18300-6(6T8T-Y3871131) (TTY 711) Provider ServiPcreosvider Se1r-v8i0c0e-s230-61381-800-230-6138 Authorization Authorizatio1n-800-453-44641-800-453-4464 Provider MediPcarol vCildaeimr Ms eCdigicnaal PCOlaiBmosx C98ig1n7a06POElBPoaxso9,8T1X70769E99l 8Paso, TX 79998

Pharmacy HelPphDaermskacy H1e-8lp00D-9e2s2k-15571-800-922-1557 Pharmacy ClaPimhsarmacy CCliaginmasAttn: MeCdiicganrae APtatnrt: DMedicare Part D

PO Box 14718PLOexBinogxto1n4,7K1Y8 4L0e5x1in2g-t4o7n1,8KY 40512-4718 Dental ServiceDsental Serv1ic-8e6s6-213-72951-(8T6T6Y-21731-17)295 (TTY 711) Provider DentPalroCvlaidimersDeCnigtanlaCPlaOimBsox C18ig8n0a37POChBaottxan1o8o8g0a3,7TCNh3a7tt4a2n2o-o8g0a3,7TN 37422-8037

CignaMedicareC.

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Insert #1 Insert #1

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HELP IS JUST A PHONE CALL AWAY.

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Call

Cigna

Medicare

Pharmacy

Service

Center

at

1-877-813-5595. CARRIER: UCSAPRSRIER: USPS Address: Address:

H7849-034 HM7A8P4D9-P0P34OMDAAPD PPO DA

Monday ? Friday, 8 a.m. ? 2 a.m. EST | Saturday, 8 a.m. ? 8 p.m. EST 793 Great C7ir9c3leGRredat Circle Rd Attn: Vicki HAinttkne:sVicki Hinkes

Insert #3 Insert #3 Insert #5 Insert #5 Insert #7 Insert #7 Insert #9 Insert #9 Insert #11 Insert #11

Insert #4 Insert #4 Insert #6 Insert #6 Insert #8 Insert #8 Insert #10 Insert #10 Insert #12 Insert #12

Nashville, TNas3h7v5i2lle1, TN 37521

Cycle Date:C2y0c2le20D9a2t0e: 20220920

PDF Date: WPDeFd DSeapte2: 1W, 2e0d2S2 e@p 2113,:3210:2528 @ 13:31:58

All

Cigna

products

and

services

are

provided

exclusively

by

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through

operating

subsidiaries

of

Cigna

Corporation,

including

Cigna

Health

and

Life Insurance Company. Mailing/MetMeraiDliantge/:Meter Date:

The

Cigna name, logos, and other Cigna marks MaxMover:MYaxMover: Y PRODUCTTPYRPOED:UMCATPTDYPEPO: MDAPLDANPPGOUADGAEL:AENGCNUTALGNEU:ME/UCNNITQLIDNU: M20/U00N0I2Q9ID4 : 20000294

are

owned

by

Cigna Intellectual Property, Inc. ? 2023 Cigna. PCOMM-2023-204-AZ

AUTH/REFEARURTAHL/R:EFFAELRSREALLIM:CFHAALSREGELI-MPPCOH/APRFGTER-UPEPON/PRF: TNRUE N/R : N GROUPNUMG:RBOLUAPNNKUM: BLANK

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MEDICARE ADVANTAGE QUICK REFERENCE GUIDE | Arizona

For Plan Year 2023

Medical management ? including precertification/ prior authorization (PA)

HMO & PPO

Clinical review services prior authorization For prior authorizations, access our interactive Prior Authorization Requirements (a searchable reference guide updated quarterly): MedicareProviders. > Forms and Practice Support > Prior Authorization Requirements. To search the Prior Authorization guide for a code, enter Ctrl+F > the five-digit code. Find prior authorization forms at MedicareProviders. > Forms and Practice Support > Prior Authorization. To submit a Prior Authorization request: Fax: 1.866.730.1896 | Call: 1.800.558.3644.

Population health operations

For Population health operations support services, call Monday ? Friday, 8 a.m. ? 5 p.m. CST.

To refer a patient: Email: CareManagementSupport@ Call: 1.866.382.0518, option 2

Supplemental benefits

Transportation | Access2Care: 1.800.285.8818 (TTY 711) In-home NP services | Optum: 1.866.217.0220 Behavioral health/Substance abuse Cigna network (please call for authorizations): 1.800.866.6534

Ancillary services

Outpatient laboratory services Labcorp: 1.602.453.8100 or 1.800.788.9743 Sonora Quest: 1.602.685.5000 or 1.800.766.6271 Ancillary services High-tech radiology authorizations (MRI, CT, PET) ? eviCore Imaging Call: 1.888.693.3297 | Fax: 1.888.693.3210

Services: ? Transition of Care ? Care Coordination

? Social Determinants of Health ? Interdisciplinary Care Team Meetings

Dental services | Administered through Cigna Dental: 1.800.367.7037 Routine vision: 1.888.353.2653

Home health care Professional Health Care Network: 1.602.395.5100 Infusion Coram Home Health Infusion: 1.480.240.3200 DME Preferred Home Health DME: 1.480.446.9010

Compliance

Coding and documentation Demographic changes and directory Pharmacy ? Part D

Network operations

To report potential fraud, waste or abuse, please contact Cigna's Special Investigations Unit:

Email: SpecialInvestigations@ ATTN: Cigna Medicare Operations

Call: 1.800.667.7145

Chronic Care Quality Initiative (CCQI) supports provider coding and documentation and the Annual Wellness Exam as well as offers CME opportunities.

Visit: MedicareProviders.az-region > Coding and Documentation

Email: Donna.Prichard@

Update contact or demographic changes: Email: Intake_PDM@ (must include old and new information, TIN, NPI, and effective date) Online directory: ProviderSearch.OnlineDirectory

Prior authorization requests: (preferred method) Home delivery: 1.877.813.5596 Fax: 1.866.845.7267

Call: 1.800.627.7534 Fax: 1.860.771.4368 Email: AZMANetworkOperations@

Forms: medicare/member-resources/drug-list-formulary Formulary Website/ Medicare Drug Formulary Reference Guide: MedicareProviders. > Pharmacy Resources Questions? Call: 1.877.813.5595

URGENT REQUEST REMINDER: Only mark requests as expedited (urgent) if waiting more than 72 hours could harm patient's health. Standard coverage determination requests are reviewed within 72 hours.

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