In July, the American Chiropractic Association (ACA) notified its members about CIGNA’s new supporting documentation requirements for certain services reported with the -25 and -59 modifiers. In a letter dated July 31, 2009, the ACA’s Insurance Relations Department contacted CIGNA and requested information that would allow us to better understand how DCs would be affected by this policy, as well as provide the membership with guidance on proper implementation in the clinic setting.
The ACA has received a response from CIGNA indicating that system problems that caused claims submitted with the -59 modifier to be processed incorrectly have been corrected and “as of August 6th, 94% of the claims have been reprocessed. The remaining claims are being re-worked and will be corrected as soon as possible.”
In regard to our concerns about out-of-network provider accessibility to CIGNA’s policy information, CIGNA assured that the secure CIGNA Web site (www.chcp.com) is accessible to both in- and out-of-network providers as long as their tax identification number and address are recorded in CIGNA’s files.
Additionally, in response to reports related to denials of claims due to submission without documentation for CPT® code 97140-59 with CMT (98940-98942), even though their policy does not apply to this code combination, CIGNA confirmed that “No supporting documentation is or has been required for these code pairs upon initial claim submission. Any claims with these code combinations that may have been incorrectly processed as noted above have been or will be corrected very shortly.”
CIGNA’s Claims Guidelines instruct providers to indicate on the claim form in Box 19/Loop 3200 that an attachment (documentation) is being sent and the claim will process correctly. CIGNA uses the standard X12 claim attachment fields to clarify documentation indicators for electronically submitted claims:
Loop 2300, PWK (paperwork) segment:
- PWKOI - type of attachment (e.g., op report, discharge summary)
- PWK02 - transmission code (e.g., mail, fax)
- PWK05 - AC (attachment control number)
- PWK06 - attachment control number
- PWK07 - attachment description (use discouraged)
Billing staff should work with their electronic billing vendor to determine what information should populate each field. Click here to view an additional listing of Attachment Codes, which define the available values for the PWKOI and PWK02 segments.
Please contact CIGNA for assistance with handling individual claim problems. If you should experience problems with the information provided by CIGNA, please contact ACA’s Insurance Relations Department at: insinfo@acatoday.org.
Source: American Chiropractic Association
