CIGNA Healthcare

Compensation Rates for Acu-Care Contract with CIGNA HealthcareCare, Inc. (HMO) and Connecticut General Life Insurance Company (PPO)
Check copy of actual contract for more details (see application for pdf document).

CIGNA HealthCare, Inc.
coverage: PPO & Group Health
effective date: January 1, 2005
reimbursement rates: Acupuncture Services

All other Covered Services shall be reimbursed at 100% of Resource Based Relative Value Scale (RBRVS) in effect by CGLIC for that calendar year based upon the Los Angeles Geographical Practice Cost Index. Unlisted or uncoded procedures will be paid at fifty percent (50%) of billed charges or up to the seventieth percentile (70%) of reasonable and customary rates whichever is less.

HMO
Prior Authorization
Services other than Emergency Services shall verify eligibility prior to providing the service and shall secure prior authorization for each Member from CIGNA. When a determination is made that Emergency Services are required, Provider shall not be required to obtain prior authorization from CIGNA, provided that Provider shall notify CIGNA as soon as possible, but in no event more than twenty-four (24) hours after the Emergency Services are provided. Failure by Provider to obtain prior authorization from CIGNA for Ancillary Services other than Emergency Services shall result in denial of payment for the unauthorized services rendered to Members.

HMO and PPO
IMPORTANT: Official Position of CIGNA - CIGNA covers acupuncture as Medically Necessary for Nausea and Vomiting related to Chemotherapy, Pregnancy or Postoperative, and for Postoperative Dental Pain. In addition, CIGNA covers acupuncture as an adjunct to standard therapy when other conservative methods have failed for EITHER of the following: Chronic Headaches, Chronic Pain (limited to Osteoarthritis of the Knee, Chronic Back and Neck Pain).

Provider Relations
Northern California - Oakland
1.800.722.6059

Los Angeles
1.800.343.9197

San Diego
1.800.368.2471

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