July 2020 newsletter
Feature Articles
New standardized appeals process for all outpatient partial hospitalization services
Beginning August 31, 2020, claim appeals for outpatient partial hospitalization (OPH)/partial hospitalization program (PHP) services need to be submitted by mail or fax. We will no longer be conducting telephonic reviews for OPH/PHP claim appeals.1
This change will help standardize our claim appeals process for all outpatient levels of care and services.
Please note that telephonic reviews will still be required if OPH/PHP services are considered a higher level of care.
What this means to you
You will be submitting OPH/PHP claim appeals using the same process as you currently use for outpatient (OP) and intensive outpatient (IOP) services.
You’ll find appeal requirements and submission information in your determination letter. We understand this represents a change in your process for submitting claim appeals for OPH/PHP services. We’re here to help you through the transition. If you have any questions, send an email to Behprep@Cigna.com.
1 Connecticut, Vermont, and Rhode Island require the option of telephonic reviews for OPH/PHP services.