CIGNA plays a prominent role in providing Medicare services to people of United States. These services are provided by the government, LLC is an entirely owned auxiliary of CIGNA Corporation - one of the nation's premiere health insurance companies. CIGNA has been serving people lead healthier, more secure lives, for more than 125 years. CIGNA and its forerunner companies have administered the federal Medicare program, since 1966. At present, CIGNA Government Services provides a variety of services for Medicare providers, suppliers and beneficiaries in 18 states and the U.S. Virgin Islands.

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Large numbers of Medicare beneficiaries and health care providers/suppliers have faith on CIGNA’s quality services every time. As a Part B and DME contracted carrier for the Centers for Medicare & Medicaid Services (CMS), we process and pay Medicare claims according to the Congressional laws and CMS rules and regulations. We do not decide who is qualified for Medicare. Presently, CIGNA Government Services provides Medicare claims processing and support services for Medicare Part B and the states of North Carolina and Idaho. On June 1, 2007, CIGNA supposed full operations for Part B (formerly DMERC Region C) for the states of: Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, U.S. Virgin Islands, Virginia, and West Virginia.

Introduction of Provider Enrollment Package

CIGNA is welcoming to Medicare Part B Provider/Supplier Enrollment Package. CIGNA Government Services have been contracted as a carrier to administer the Medicare Part B program by The Centers for Medicare & Medicaid Services (CMS). CIGNA is committed to achieving the highest standards of quality and service to their providers, beneficiaries and government entities they serve. CIGNA Government Services is responsible for providing information concerning enrollment into the Medicare program, processing Medicare claims, and communicating changes in the Medicare guidelines. Extensive research is required to processing of an eligible Medicare provider/supplier application to prove that all information provided is correct and all appropriate attachments are supplied. Please note that there is important information which is Considerable to the enrollment process including but not limited to the completion of the CMS-855 enrollment application(s) (2008 version), Authorization Agreement for Electronic Funds Transfer (CMS-588), submission of the National Provider Identifier (NPI) Notification, requirements for P.O. Box ownership, clinical lab registration requirements, and other important Medicare enrollment information.

Benefits of Participation in the Medicare Programe

A fee schedule is five percent higher on all services which could be or are paid under the physician fee schedule. This five percent differential applies regardless of what entity bills for the service.
No limit on the amount of charges submitted to Medicare. This allows the participating physician to use the same fee schedule for Medicare and non-Medicare patients.
Automatic crossover of claims to Medigap insurers.

In the online Medicare Participating Physician Directory, the provider name, address, and telephone number are listed. At CIGNA’s website, directory can be found. User can search for Medicare Participating Physicians at the online directory. Providers may also log on to Cigna’s official website for huge information of Medicare program.

Though suppliers may enroll in the Medicare program or change an enrollment status at anytime. There are only two circumstances for providers either they may enroll in or cease enrollment from the participation program. First is within 90 days of opening new enrollment into the Medicare program. And second is during the annual open enrollment period.

Physicians and suppliers can voluntarily enter into an agreement to accept assignment for all services rendered to Medicare beneficiaries. Duration of this agreement is of 12-months begins from 1st January, of every year. The agreement is effective the date it is received by the carrier.

Please note: If a provider is under going a tax ID change or changing status, i.e., leaving or forming new groups, the Participation Agreement does not automatically roll over. Please be sure to check with Provider Enrollment if you are in doubt of your need to submit a new participation agreement.

Participating Provider Facts

By Medicare program, it is determined that Accepting assignment means the service provider has made a "participating agreement" with Medicare to accept the "allowable charge", as full payment for such service. Generally, Medicare pays 80 percent of the "allowable charge" and 20 percentages is liable to the provider. In addition to the coinsurance, the beneficiary is responsible for paying the annual Part B deductible and for paying any non-covered services.

A Medicare provider number is received to bill Medicare for services rendered by a participating provider. To verify whether provider’s services is covered under the Medicare Participating Agreement or not, provider must know the status of the Medicare provider number used to bill their services. Physicians, clinics, groups, non-physicians, and other health care professionals can have provider numbers.
Most of the clinics or groups of physicians are listed only under the clinic or group name. In these circumstances, providers need to know whether or not the clinic or group has a provider number. All physicians in a clinic must agree to participate before the clinic can hold a provider number.

A few physicians practice in more than one clinic. In this case, one clinic may hold a Medicare providing number while the second may not. Before services are provided, be sure to check with the office provider expect to visit to ensure your services will be covered.

A physician may hold a Medicare provider number under his/her individual name but also practice in a clinic or group. If you receive services at the clinic or group, you should ensure that the clinic or group also holds a Medicare provider number.

The MEDPARD contains the addresses provided by the physicians and suppliers. CIGNA has tried to verify this information is accurate. However, Medicare recommends that you call to verify the participant's information and provider number before making an appointment.

The scheduled participating provider enrollment period is held each year in the fall. At that time, physicians can choose to enter or leave the program. Shortly after the enrollment period, a revised MEDPARD will be issued.

Detailed information of how to locate a Medicare participating provider is contained in the MEDPARD.

Instructions have been provided to you as a guide to help in the completion of your Provider Enrollment 855 application. 

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