The Practitioner Connection
The right help at the right time!
ACCESS TO OUTPATIENT CARE
Cigna is committed to providing excellent service and quality of care to our membership. Cigna offers the people it serves access to care based on their clinical need. Cigna offers Crisis Stabilization, Intermediate Care and Routine access levels. As a network practitioner network it is important that you understand the levels of care as you can elect to accept for treatment members requiring any or all of the following care access levels:
Crisis Stabilization – A practitioner sub-network available for people in crisis who need to be seen within 6- 24 hours, with the focus of the session being immediate stabilization. The session should include collecting a comprehensive psychiatric and medical history, assessment for safety risks, mental status evaluation and determination if substance abuse is present. As a result of the session the practitioner is expected to develop a short term crisis intervention treatment plan as well as be able to intensify treatment plans as needed to avoid higher levels of care. Practitioners must be willing to collaborate with Cigna, the customer’s primary care physician (PCP) and other mental health providers as needed to facilitate the patient’s care. Practitioners in this sub-network can choose to participate on a 24-hour basis or during office hours only. Those practitioners who chose to participate on a 24-hour basis must be available after office hours by cell phone, pager or answering service. Your voicemail should not refer customers to the nearest emergency room in the event of a psychiatric emergency. Because Cigna will be requesting immediate access to care, the session will very likely be longer than the traditional 55 minutes and coordination of care may be required. The Cigna representative may authorize a 99245 (crisis intervention) CPT code or an extended 90801. If you are interested in more information about the Crisis Stabilization network, please refer to page 25 of the Provider Resource Packet or contact your Provider Relations Representative. If you elect to participate, an attestation form is required.
Intermediate Care – Intermediate Care is a level of intervention that provides precautionary and preventive care to a person who presents with a level of acuity that, if not addressed within 48 hours, could escalate to a higher level of care. The goal of our Intermediate Care network is to successfully link complex cases with practitioners who have the clinical expertise to manage specific diagnoses/problems for ongoing treatment. Cigna may also utilize the Intermediate Care network to identify practitioners who may be able to accept customers recently discharged from higher levels of care. Cigna emphasizes the need for a follow-up appointment within 7 days of discharge for those people discharged from an inpatient setting. The session should include collecting a comprehensive psychiatric and medical history, assessment for safety risks and determination if substance abuse is present. If this level of care is requested by a Cigna representative, the service will be authorized as a 90808, in anticipation of a session that exceeds the traditional 55 minute session. If you are interested in more information about the Intermediate network please refer to page 26 of the Provider Resource Packet or contact your Provider Relations Representative.
Routine – Routine referrals are expected to be seen within 10 days.
As a practitioner you may also call Cigna to request authorization for a crisis or intermediate appointment if you feel that it is clinically necessary. If you would like to request a clinical review please call the number on the back of the member's ID card.
Please make every effort to keep Cigna updated with your practice information as well as your availability. If you will be unavailable for a period of time due to a vacation or your practice is overbooked, you can be made temporarily unavailable in Cigna's provider database and on our website. If you need to update your information, you can do so online at www.cignabehavioral.com , by calling your Provider Relations Representative or by submitting the Provider Update Form located in the Provider Resource Packet.
Cigna is committed to working collaboratively with providers around member care. Please feel free to contact the Provider Relations department for more information about access levels or to update you information.
Other Featured Articles: