LEGAL RESOURCES

Physicians Can Resubmit Previously Denied CAD Mammography Claims to Cigna

Thanks to the work of the Medical Society of the State of New York and other medical societies involved with the Physicians Advocacy Institute (PAI), physicians may resubmit their previously denied CAD mammography claims to CIGNA. This opportunity to resubmit claims is another victory resulting from the settlements in the national MDL class action lawsuits against the nation’s for-profit health plans. The Medical Society of the State of New York and PAI used the formal compliance dispute resolution process that was part of the CIGNA Settlement Agreement to force CIGNA to pay these claims.

Eligible claims must:

• Involve CPT® Codes 76082 or 76082 as add-on codes with 76090, 76091, or 76092 and
• Have been submitted between January 1, 2004, when the CAD Mammography add-on codes became effective, and October 10, 2004, when CIGNA began paying the claims.

Resubmitting claims is simple. Download the spreadsheet from www.hmosettlements.com or www.CIGNA.com.

Completed spreadsheets and questions can be e-mailed to: [email protected].

Physicians without access to e-mail can mail their completed spreadsheets to:
CIGNA R&R Department P&C
P.O. Box 9018
Sherman, TX 75091-9018

Direct questions to:
Medical Society of the State of New York
Office of General Counsel or
Division of Socio-Medical Economics at:
(516) 488-6100, extension 352 or 426, or

CIGNA Compliance Dispute Facilitator:
Deborah Winegard, at (404) 881-8900.

Claims can be resubmitted from June 1, 2007 through December 1, 2007.

Any physician who believes that Aetna, CIGNA, HealthNet, Humana or Anthem/Wellpoint, are violating the terms of their settlement agreements should contact:
Medical Society of the State of New York
Office of General Counsel
(516) 488-6100, extension 352 or
Division of Socio-Medical Economics
(516) 488-6100, extension 426.