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Review your CIGNA contract - before September 4!

The CIGNA multi-district litigation (MDL) class action settlement agreement protections END September 4, 2007. The termination of the CIGNA settlement agreement means that CIGNA no longer has to comply with its settlement terms. However, the termination of the CIGNA settlement does not affect CIGNA’s obligation to pay physicians who submitted valid claims for damages from the Claim Distribution Fund and have not yet been paid.

All contracted physicians with CIGNA are encouraged to review their contracts and contact their provider representatives to determine how termination of the MDL settlement will affect their business relationship with CIGNA. The reverse side of this flyer is a checklist that contains a number of key settlement terms. Physicians are encouraged to download the entire settlement document from www.hmosettlements.com to view all of the settlement provisions.

Aetna, Health Net, Humana and WellPoint (Anthem) settlements remain in effect.

The AMA encourages all physicians to learn about the protections offered physicians through the Aetna, Health Net, Humana and WellPoint (Anthem) settlements that remain in effect. Physicians may consider filing a compliance dispute, (a free, simple enforcement process) if prohibited clauses are contained in a contract submitted by the settling health insurer or the settling health insurer fails to adhere to the terms of its settlement. Physicians are encouraged to hold the settling health plans accountable to their respective settlements. The Blue Cross Blue Shield settlement is anticipated to be effective by the end of 2007. Visit the AMA Web site at www.ama-assn.org/go/settlements for additional information on these settlements, including the compliance dispute process.

CIGNA’s good faith continuation of business practices

The Physicians Advocacy Institute (PAI) is working with CIGNA in an effort to persuade CIGNA to voluntarily continue most of its business practices required by the settlement in an effort to foster continued communication with physicians and transparency of the payment process. As a result of these discussions, PAI has informed the AMA that CIGNA has

indicated the following:

Business practices which will remain in effect:

  • Adherence to AMA Current Procedural Terminology (CPT®)* codes, guidelines and conventions

  • Availability of fee schedules

  • No downcoding of CPT codes for evaluation and management (E&M) services

  • Payment of reasonable fees for vaccines and injectibles

  • 180 day timely filing requirements on claim submissions

B u s i n e s s p r a c t i c e , w h i c h m a y c h a n g e : Clinically-based medical necessity definition, as defined in the settlement Reinstatement of all-products clauses Increased frequency of fee schedule changes

Business practice that will change:

  • Overpayment recovery period will be extended

  • No late payment interest on self-funded business

  • Reserve right to contract with rental network PPOs

  • Compliance dispute process terminated

The AMA commends the PAI for its efforts on behalf of physicians along with CIGNA for its willingness to continue many of its settlement provisions. The AMA urges CIGNA to continue its commitment to disclose certain business practices and provide physicians with greater transparency in its claims processing and payment practices.

*CPT is a registered trademark of the American Medical Association © 2007 American Medical Association

Visit the AMA PSA Web site at www.ama-assn.org/go/settlements for more information on the MDL and Blue Cross Blue Shield parties’ settlements.

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