Region C untangles claims snag

Monday, December 31, 2007

NASHVILLE, Tenn. – Starting in December, Cigna expected to be caught up on a backlog of claims that has bedeviled the Jurisdiction C Medicare Administrative Contractor (MAC) since it took over from Palmetto July 1.
“That’s what they’re saying,” said Joan Cross, a member of the Region C Advisory Council. “In their defense, they did get slammed with a bunch of things from Palmetto.”
Cigna has been hiring and training employees, as well as providing refresher training, she said. HME
“They’re trying to bring them up to speed, but there’s a learning curve” she said. “That slows things down.”
Cross, who co-owns Bradenton, Fla.-based C&C Homecare, said she was getting CPAP claims denied because she lacked CMNs.
“There is no CMN for a CPAP,” she said. “I called them. They put me on hold for 10 or 15 minutes, then they came back and told me, ‘That’s fine, we got what we needed, the CMN from you.’ I said, ‘If you got a CMN from me, someone is hacking into my computer.”
For providers in Virginia and West Virginia, who moved from Jurisdiction B to C in June, the transition has been especially difficult.
“The main (reason for denials) is either the claims are not prescribed by a physician or the prescription is not current,” said Jeff Brooks, owner of Physicians Choice in Hurricane, W.Va. “Even if the initial claim was paid by Palmetto, subsequent claims have been denied.”
Heavy call volume to Cigna has also frustrated providers, but the MAC reported that has improved significantly, dropping from 15,000 call attempts per day from June through Oct. 1, to 4,000 as of Oct. 8.