# Cigna Policy/Physician Assistants



## adawson5 (Jul 14, 2015)

I have looked and can not find Cigna's policy for billing physician assistants.  I understand that Cigna does not credential PAs, and when I ask for policies, I'm directed to their website.  

I just need a hardcopy of their billing policies for PAs, it shouldn't be this hard to find, should it?

Any help is appreciated.

Thanks.


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## kmuerth (Jul 14, 2015)

I found these online...the first link is a cigna 2013 reference guide that says they do credential nurse practitioners and physician assistants. The second link helps you on how to go about dealing with carriers like them.

http://www.google.com/url?sa=t&rct=...GsnJAC&usg=AFQjCNE8pGjnYnvZT6wyUwhyaN1Lz-95LA


http://www.aafp.org/fpm/2006/0500/p45.html 
Billing health plans

Health plans are free to set their own policies for credentialing NPPs and providing reimbursement for their services. Some plans credential NPPs and allow their services to be billed under the NPPs' provider numbers. Other plans do not and instruct practices to bill for services provided by NPPs as if the physician had provided them, using the physician's name and provider number on the claim. Medicare refers to this arrangement as ?incident-to? billing and has a set of rules that apply to it that will be explained later. Health plans that allow this type of billing may do so with fewer restrictions than Medicare. Unfortunately, this leaves you needing to determine the policy of each health plan with which you contract. Here are some key questions to ask: 

?Do you credential nonphysician providers?


?Do you include them in your provider listing and allow patients to select them as primary care providers?


?Do you require that submitted claims use the NPP's name and provider number, or the physician's name and provider number?


?Do you require any specific level of supervision or protocol?


?If we bill for the services of the NPP using the physician's provider number, and the patient's usual physician is not in the office, should we bill under the usual physician's name or the name of a physician who is in the office?


?What is your reimbursement rate for NPP services?



The reimbursement amount for NPP services varies among payers. Many health plan contracts agree to pay for services billed under NPP provider numbers at 85 percent of the physician fee schedule. If you employ an NPP or anticipate hiring one, you might be able to negotiate a better reimbursement rate when you evaluate your next contract. Of course, whether your practice can do this is largely dependent on how much the insurance company wants your practice in its network. Sometimes this is easier for larger practices, but even smaller, rural practices can often negotiate if they are among the few family physicians in the area, for example.


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## adawson5 (Jul 14, 2015)

Thanks for the reply.  Cigna will credential, if the provider directly contracts with Cigna.  We have a group contract.

Like I said, the rep I talked to just kept referring me to their online policies.  I asked if they followed Medicare guidelines for incident-to, and they could tell me.  Incident-to does not work for our situation, as the PA's are seeing patients without a supervising physician in the office.  

Any other advice/help will be appreciated.

Thanks.


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## mitchellde (Jul 14, 2015)

That is true you cannot bill under the physician if the physician is not present at the time of service.  And yes to credential the PA normally the supervising provider must be directly contracted.  And the individual state laws play a part.


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