Systems
Products
EAP
Eligibility
HIPAA
100
This system houses member information such as their eligibility and benefits
CAMS
100
This product is offered as an add-on to traditional benefits and includes anywhere from 3 to 12 free sessions for patients and household members
EAP
100
This EAP product type offers a limit of 3 visits per authorization
AS/Assessment
100
Where do we receive eligibility and demographic information from?
The employer
100
This cannot be released until both the provider and the member have been HIPAA validated over the phone
PHI/Protected Health Information
200
This system houses information about health care professionals such as addresses, phone numbers and network status
PMRS
200
This product is offered as an add-on to traditional benefits and includes 3 free sessions for members on the plan
MAP
200
This EAP product offers up to 12 visits per authorization
STC/Short Term Counseling
200
If benefits or eligibility cannot be confirmed or quoted you would send this type of request
REGIS
200
Before leaving your desk, you need to do this step
Lock your screen!
Windows + L
or Ctrl + Alt + Del & log off
300
This system allows us to view account exceptions for groups who have Cigna insurance for their employees
OLAM
300
This product is considered a "carve-in" products, claims are handled at CHC and most use the Guaranteed Cost funding mechanism
PPO
300
This is the CPT code that must be billed for EAP services
99404
300
How can we determine eligibility for a member with a TruCare pop up?
Transfer to Claims!
300
This information is required to HIPAA validate a provider
TIN/NPI & provider's name
400
This system allows us to check deductible & out of pocket max accumulations, other insurance and check parity for HMO and Employer Group Plans
DG
400
This product often does not offer out of network benefits and is considered a "carve-in" product
HMO
400
This is the system used to determine if the member is eligible for EAP and how many visits they're eligible for
OLAM
400
This icon is the shape of a computer in CAMS and can help clarify eligibility discrepancies and is updated whenever a REGIS is sent
PC comments
400
This information is required to validate HIPAA for a patient
Member ID
First & last name
DOB
Address
Phone Number
500
This system allows us to check deductible & out of pocket max accumulations, other insurance and check parity for PPO plans
OneView
500
This funding mechanism allows Cigna access to the employer's back account in order to reimburse provider for services rendered
ASO/Self Funded
500
This criteria needs to be met for a provider to be eligible to receive payment for EAP services: the patients account must offer EAP, the provider has to be INN and ________
Be a masters or psychologist level provider
500
Name the 3 types of registrations we see in CAMS
Managed
EAP
Integrated
500
How do you HIPAA validate a caller from a non-Cigna insurer?
Get their callback number, put them on hold and make a call out to that number to verify they're calling from that insurance company