The Cigna Healthcare^SM Medicare Advantage Preferred Provider Organization (PPO) Attribution team has made updates to the Medicare primary care provider (PCP) attribution methodology that are now effective to improve patient alignment, which will enhance coordination of care and strengthen established relationships.

Customers with Cigna Healthcare Medicare Advantage preferred provider organization (PPO) plans are not required to select a primary care provider (PCP) at the time of enrollment; however, we encourage them to do so. If a customer does not select a PCP, we use our attribution methodology to align them with a provider for care management.

How it works

When a provider group supplies us with a roster of PPO network–participating providers, we use that information to identify patients with Cigna Healthcare Medicare Advantage coverage who are receiving primary care services from their group. We attribute patients by prioritizing their selection of a PCP or scheduling of a primary care preventive visit. We also use several data sources to align patients to PCPs, including eligibility data reflecting patient PCP selection and medical and pharmacy claims data. Our attribution methodology uses the latest industry insights to capture established patient relationships and maximize the volume of patients aligned to a provider group.

The PCP attribution methodology is applied year-round and updated with the latest claims data available each month. As a result of the methodology changes, providers may see additional aligned patients on their reports as data is updated.

Additional information
Additional information on the PCP attribution methodology is available on the Cigna Healthcare Medicare Advantage Provider website  (MedicareProviders.Cigna.com > Forms & Practice Support > Annual Enrollment Period Provider Resources Toolkit > Primary Care Provider Attribution Methodology PPT and Primary Care Provider Attribution Methodology Overview)

If you have any questions, connect with your market representative.