How to do Business with Cigna 

 

National Buying Needs:

Brokerage/Insurance firm to manage:

 

Pre Sale (Brokerage arm) 

-  Advertise and promote to agents

-  Rate and quote CGI (life, ltd, std) products

Post Sale (Administration arm) 

-  Process Group app and employee applications

-  Electronically issue Group policy and certificates

-  Provide ongoing billing electronically or Group Portal

-  Receive ongoing premium electronically

-  Pay agents via ACH; post commission statement on Portal

-  Provide customer service for all services except claims

-  Confirm eligibility, salary, and coverage before sending claims to CGI

 

Electronic Data Interchange (EDI): electronic medical/ dental claim submission

• Electronic Mailroom: the ability to take paper mail (claims, correspondence, invoices, health surveys etc..) add convert them into electronic format and then submitted electronically to Cigna.

 

• Overpayment Recovery:

-  Data Mining and Identification: the ability to review large amounts of medical claim data to identify potential overpayments.

-  Coordination of Benefits (determining if Cigna has overpaid based on primary coverage)

-  Diagnostic Related Group (DRG) auditing for hospital records

-  Credit balance auditing

-  Subrogation claims identification and recovery

 

 Biometrics – defined as suppliers providing biometric services at client sites.  

• Independent Review Organizations (IRO)-  defined as suppliers performing independent medical exams and peer review services.

 

• Functional capacity exams

 

• Vocational Rehab services

 

• Technical Products         

 . Digital payments systems

• Plan decision support tools
• Location based messaging
• Bill negotiation service
• Tele-health & Remote Monitoring
• Cost estimator
• Provider rating
• Appointment scheduler
• Loyalty/Retention Program

 

  Localized Buying Needs:

The following services generally support local RFP activities

• Onsite non-clinical staffing
• Printed Materials ( PII& PHI data – compliance needed)
• Health & Wellness Management
• Massage Therapy
• Health Education Seminars
• FMLA management
• Commuter management program
• Healthy cooking demonstrations

 

Creative Value- Add solutions in support of Medical and Dental sales activity