Another Payer Investigation-Cigna disregards contracted reimbursement rates
Granite GRC
Providing strategic and day-to-day consulting services to organizations optimizing resources and managing risk.
It is time to bring awareness to another contract violation by a highly recognizable health insurance company. Cigna is a client of MultiPlan, the country's largest “third-party network” company, which allows Cigna to contract with MultiPlan providers. Sometimes Cigna applies the MultiPlan contracted rates when it processes claims, but not always. Participating providers have been shortchanged by Cigna utilizing lower reimbursement methodologies to claims for nonparticipating or out-of-network providers. This tactic has led to underpaid claims and balance billing for patients. As a result, providers and patients are not being presented with fair or accurate payment for medical services.
Patients and providers have taken notice. In September, the American Medical Association (AMA) has joined the Medical Society of New Jersey (MSNJ) and the Washington State Medical Association (WSMA) as plaintiffs in a lawsuit alleging that Cigna failed to pay medical claims based on the physicians’ contracts with MultiPlan Corp. According to the suit, MultiPlan has over 1.2 million providers contracts. This case can be followed through the AMA Litigation Center Litigation Center cases | American Medical Association (ama-assn.org).
Health Insurers cannot be permitted to take short cuts that reduce provider payments inappropriately or leave patients with inappropriate balances. The rights of patients and physicians throughout the nation need to be safeguarded. Granite GRC is here to help in analyzing Cigna and other payer’s contracts and reimbursement to ensure you receive accurate payments. Contact us today with any questions you may have!
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Contact Consultant Jennifer Waid, CPC, CPMA, CCC at Granite GRC
717.556.1090 or at [email protected]