Important Claims Submission Tip: Submit the Claim Coversheet

When submitting a claim for reimbursement, please attach your Provider Claim Coversheet (which identifies your CIEB Provider ID, payment method and bank details) with every invoice you submit to CIEB.  This will facilitate a prompt payment in the correct payment method (i.e. wire, check, etc.).  If you need a copy of your Provider Claim Coversheet please email ciebprovider@cigna.com.

Have your Contact and or Banking details recently changed?

If the contact person for inquiries for CIEB or your facility’s banking details has changed, please email ciebprovider@cigna.com with the following information so we can update our records:

• Contact name and contact information for your facility’s CIEB contact person
• Correct method of payment
• Currency in which you wish to be reimbursed
• Banking details (if you receive wire transfers) or the correct address (if you request check reimbursement)

Why should I receive wire transfers?
If you are currently not receiving wire transfers, you may want to consider this reimbursement option.  It is a faster, safer way to receive payment from CIEB.  Please note that only international banks are eligible for wire transfers.

Guarantee of Payments (GOPs) from the Provider Portal

A quick and easy way to access a GOP is through the provider portal, www.CIGNAenvoy.com.   Simply print the Explanation of Benefits of the customer as the GOP and include it when you submit your invoices.  This will indicate the benefits of the customer at that specific point in time. 

Medical Review

Certain services require Medical Review before the claim can be paid.  We have listed a few services that are commonly submitted for Medical Review and the necessary information needed for the Medical Review team to reach a conclusion.

Bariatric surgery
Psychological evaluation
Nutritional evaluation
Medical evaluation
Surgical evaluation
Co-morbid conditions
Diet history (medical records documenting active participation and reasonable compliance with at least one physician-directed weight loss program for a minimum of six months within the past 2 years)
Height, weight, and body mass index

Infertility
Complete history and physical exam of both partners as it pertains to infertility
Results of lab and x-ray tests including ultrasound and sonograms
Dosage and frequency of medications prescribed
Proposed treatment plan to include prognosis
Medical records documenting all treatments rendered to date

Therapy - occupational, physical & speech
Letter or prescription from the doctor to include the diagnosis
Initial therapy evaluation
Treatment plan to include the prognosis, frequency, duration and expected length of treatment

Varicose Veins
Measurement of incompetent vein(s) – diameter (usually in millimeters)
Medical Records, including symptoms and duration of symptoms
Previous methods tried and failed, including duration of trial(s)
Results of Doppler studies (if available)

Below is a list of more services that require Medical Review:
(This list is not comprehensive)
Abdominoplasty
Bariatric surgery
Blepharoplasty surgery
Breast reduction
Clinical trials
CPAP machine
Durable Medical Equipment
Foot orthotics
Genetic testing
Home Health Care
Home Infusion therapy
Infertility
Inpatient hospital admission
Neuropsychological assessment, evaluation & testing
Nutritional supplements & formulas
Occupational therapy
Organ transplants
Orthognathic surgery
Physical therapy
Prosthetics
Rhinoplasty
Septoplasty
Speech therapy
Varicose vein sclerotherapy/surgery

Appeals Tips

If you would like to submit an appeal, you may do so by any of the following methods within the required timeframe:

• Via email to ciebprovider@cigna.com
• Via fax to 302-797-3150
• Via mail to the following address:

          CIGNA International Expatriate Benefits
          Attn:   Appeals
          P.O. Box 15800 
          Wilmington, DE 19850

Please submit any supporting documentation that applies to your specific appeal. Below are some examples that may apply:

• Guarantee of Payment
• Print out of provider portal screen showing customer benefits that were quoted
• Medical report
• Letter of medical necessity
• Previous trials of treatment
• X-rays or lab results

Appeals that occur prior to service are answered within 15 calendar days.  Appeals that occur after care has been given are answered within 30 calendar days.  Urgent pre-service appeals are answered within 72 hours.

We’re Always Here to Help

CIEB’s Provider Relations Team is here to make your experience with us positive and worthwhile.  Please contact us with your questions, comments or concerns at any time:
CIEBprovider@CIGNA.com.

If you are not yet a contracted health care professional or facility, we are always pleased to describe the advantages of establishing a contract with us, such as direct pay agreements, a listing in our International Provider Directory on our website for covered individuals, and perhaps most important, assurance of prompt, accurate payment in more than 100 currencies. Please contact Cindy Gatanis at Cynthia.Gatanis@cigna.com for further details.

DISCLAIMER: “CIGNA” refers to CIGNA Corporation and/or its subsidiaries and affiliates. CIGNA International and CIGNA International Expatriate Benefits refer to these subsidiaries and affiliates. Products and services are provided by these subsidiaries, affiliates and other contracted companies and not by CIGNA Corporation. “CIGNA” is a registered service mark. 

This material is provided for informational purposes only.  It is believed accurate as of the date of publication and is subject to change.  Such material should not be relied upon as legal, medical, or tax advice.  As always, we recommend that you consult with your independent legal, medical, and/or tax advisors.  Products and services may not be available in all jurisdictions and are expressly excluded where prohibited by applicable law.

Copyright 2010 CIGNA Corporation