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.
4060MR 4- 0C6ig0nMaRA-chCiiegvneaMAcehdiiecvaereM(HedMicOarCe-S(HNMP)O C-SNP)
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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
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Cigna Intellectual Property, Inc. ? 2023 Cigna. PCOMM-2023-204-AZ
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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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