News from the NIC - Cigna

The NYSCA Insurance Committee (The NIC) is requesting your assistance as we compile recent blinded examples of claims which have not been acknowledged or processed and in a timely manner by Cigna.  These are claims which do not involve American Specialty Health (ASH), but are solely the responsibility of Cigna.  Remember: Health Plans subject to the laws of New York are required to acknowledge or process clean claims within 30 or 45 days of receipt.  Failure to do so can result in interest and penalties.

Cigna appears to have delegated certain administrative functions to ASH in New York; however, this delegation does not include all regions / all Cigna insureds.  This may be part of the issue; however, it remains the responsibility of the carrier to process claims in a timely manner.

  • Example 1: When claims are correctly submitted to Cigna, they may be incorrectly forwarded from Cigna to ASH for processing.  Since ASH has not been delegated to administer benefits for those Cigna plans, ASH sends a denial advising the provider to bill the payer (Cigna) - where the claim was originally sent.  Rebilling Cigna can result in the same pattern or simply a denial due to duplicate submission.  One 'work around' includes attaching the ASH denial to the original claim and then resubmitting to Cigna. 
  • Example 2: When Cigna is secondary, claims forwarded for coordination of benefits may not be acknowledged or processed correctly by Cigna.  Note: if Cigna has delegated claims processing to ASH (common in the downstate region), those claims should be submitted directly to ASH for coordination of benefits.

At the request of NYSCA, ASH has reached out to Cigna on several occasions; however, the issue remains.  The NIC has reached out to Cigna, who has recently acknowledged their awareness of the issue.

Although the NIC has received examples from a few NYSCA members we are asking for additional examples as we reach out to the Department of Financial Services for assistance.  Please send your redacted examples to NYSCA via fax to: 518-785-6352.

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