There are various reasons why claims may be pended or denied, including instances where they are inadvertently paid under an incorrect patient profile. Oftentimes, the root cause can be as simple as submitting a claim with incorrect patient information. These errors not only result in overpayments— which particularly affect self-funded clients when the claim does not pertain to their employee or dependent—but also increase administrative burden and potentially delay reimbursement.

A review of Cigna Healthcare^® claims data indicates that incorrect patient selection at the facility level is often the leading cause of delay.

To reduce the potential for billing errors, follow these best practices for patient verification:

• Confirm the patient’s full name, date of birth, and customer ID number before proceeding.
• Log in to the Cigna for Health Care Professionals portal (CignaforHCP.com) and use the Eligibility and Benefits tool to verify coverage.

It is critical during the verification process to:  

• Refer to the pop-up confirmation box on CignaforHCP.com when searching for patient information to verify multiple data points as names and dates of birth may be the same for multiple patients. (See example below.)

Helpful resources

• Eligibility and benefits tutorial
• Step-by-step guide: Access Patient Benefits, Eligibility, and ID Cards Online

Questions

For assistance with the verification process or patient eligibility, reach out to your Provider Relations representative, or call Cigna Healthcare Provider Service at 800.88Cigna (882.4462).