The Practitioner Connection
Volume XXVI, 2nd Quarter

2007 KEY FINDINGS OF THE Quality AND UTILIZATION MANAGMENT PROGRAM

Annually, CIGNA evaluates and distributes information on the results of its Quality Management and Utilization Management Program effectiveness and efficiency to identify improvements made in the past year that resulted from actions taken, identify barriers to achieving successes, and to establish or update goals for 2008. Key findings and interventions that drove results are presented for 2007. Both clinical and service improvements are noted.

QUICK FACTS ABOUT AUTISM AND OTHER PERVASIVE DEVELOPMENTAL DISORDERS

The prevalence of Autism and certain other Pervasive Developmental Disorders are on the rise. At the same time, there seems to be some evidence that early recognition and intervention improves prognosis. Associated symptoms of Autism and the Pervasive Developmental Disorders can overlap or be confused with other disorders. This article will present some quick facts about Autism and the Pervasive Developmental Disorders.

EAP SUBSTANCE ABUSE ASSESSMENT AND MANAGEMENT REFERRALS

Substance Abuse is the most common reason employees are management-referred by their employers to CIGNA. Given this fact, it is important that EAP practitioners consider the needs of both the employee and the employer when making recommendations following a Substance Abuse assessment. This article compiles some “best practices” as a resource for providers.

CIGNA'S PREVENTIVE HEALTH PROGRAMS

CIGNA maintains several Preventive Health Programs for participants. In 2007, three separate programs provided early intervention and support to empower participants to better manage and to reduce the impact of progressive conditions. Program results are given for these programs with discussion of results and future directions. Findings suggest that these programs are meeting established objectives and areas of opportunity for future program development ar being identified.

PROVIDER SATISFACTION SURVEY

In June, CIGNA will launch an enhanced version of the Provider Satisfaction Survey available to participants via the web. This tool will allow CIGNA to continuously improve the quality of our network as well as to comply with NCQA requirements regarding provider concerns.

CLAIM OFFSETTING PROCESS

When a claim is adjusted due to an overpayment, many times the claim will go through a process of being either offset or a payment being requested. While the process can take a few different turns due to state laws there is a basic process that CIGNA follows for overpayments.

GAPS IN CARE FOR BIPOLAR DISORDER

To address medication compliance for those Members who may have Bipolar Disorder, a new clinical program now monitors medication compliance rates in combination with member and practitioner outreach and tools that encourage optimal outcome. The program materials are available on our Web site

CIGNA MEDICAL MANAGEMENT PROGRAM

The CIGNA Medical Management Program (formerly known as the Provider Guide) is an informative resource for providers and practice administrators. Additionally, it is an extension of the Participating Provider Agreement, so it is important to be aware of the information within the Medical Management Program (MMP) as it impacts a provider's relationship with CIGNA.This article will highlight some of the information featured in the Medical Management Program.