CIGNA Funds Overview

1. CIGNA Funds Overview • Category A Settlement Fund* (No Documentation): $30 million OR/ • Claim Distribution Fund* (No Limitation/Cap) • Category 1 Compensation: Specific Code List • Category 2 Compensation: Other Codes • Medical Necessity Claims Compensation • Foundation Fund: $15 million * Physician may contribute to Foundation Fund

2. Additional Information on CIGNA Claims Submission • Timeframe: 180 Days from Notification • Covers HMO, PPO and Indemnity Patients • Physician Groups/Organizations May File for Physicians Working for them at the time claims were made, without signatures. Must be same provider ID number. • Physicians may file for Category A regardless of whether they submitted claims to CIGNA HealthCare

3. Additional Information on CIGNA Claims Submission: Timeframe • September 2, 2003: Preliminary Approval Hearing & Order • December 18, 2003: Fairness Hearing • October 2003: First Settlement Notice Mailed • February 12, 2004: Appeals Filed • April 22, 2004: Appeals Dismissed • Week of May 3, 2004: Extensions to be Filed to Resolve Several Issues (Electronic Filings, etc.) • June 15, 2004 (Estimated) Second Settlement Notice Mailed • June 15-December 15, 2004: 180 Days to Submit Claims to Settlement Administrator

4. Additional Information on CIGNA Claims Submission: Category A • Formula • No. of Retired Physicians, plus No. of Deceased Physicians (Times Two); Plus No. of Active Physicians Sending in Category A Form= No. Physicians • No. Physicians Divided by$30,000,000 = Result • Result = Amount Paid Per Physician • Comment: The Amount Per Physician will vary significantly depending on number of physicians applying for Category A Funds (Estimated Range: $50-$400)

5. Additional Information on CIGNA Claims Submission: Category One • CPT Codes and Code Sets Underpaid, Bundled or Downcoded • Specified Time Periods from 1/1/96-12/31/03 • Paid at Amounts Specified on Category One List • Specific Documentation and Certification Requirements Found in Draft Notice • Category One Code List: Exhibit 1 of the CIGNA Settlement Agreement

6. Additional Information on CIGNA Claims Submission: Category Two • All Other CPT Codes Improperly Denied, Reduced • Also Includes Code Sets Outside of the Specified Time Periods in Category 1 • Failure to recognize Modifiers 50, 51, RT, LT, FA-F9 and TA-T9 • HCPCS Level II “J” codes translated into an incorrect or overbroad CPT Code

7. Additional Information on CIGNA Claims Submission: Category Two • Paid at 100% of June 1, 2001 Medicare Rates • Request/Obtain Your Facilitation List from Settlement Administrator • Specific Documentation and Certification Requirements Found in Draft Notice • May require: HCFA 1500, EOB & Medical Records

8. Additional Information on CIGNA Claims Submission: Category Two • Claims Submission • Cover Sheet • Certification • Documentation • Notified of Inadequate Documentation within 14 Days: 30 Days to Resubmit • External Review of Re-Denials

9. Additional Information on CIGNA Claims Submission: Medical Necessity • Resubmit if Improperly Denied Based On: • Medically Necessity • Experimental or Investigational • Does not include Coverage Determinations • If Re-Denied, CIGNA Must Submit to External Reviewer

10. CIGNA Claims Submission • Read Claim Notice Form Carefully • Outstanding Issues: • Electronic vs. Manual Submission • Documentation Requirements: Facilitation List • Vendors: Certification • Find Settlement Agreement and All Forms: http://www.hmosettlements.com

11. North Carolina Managed Care Patient Assistance Program • Created by NC Patient’s Bill of Rights (2001) • Located in Attorney General Roy Cooper’s Office • Patient Assistance Specialists “provide advice to consumers, caregivers, and providers about insurance and managed care issues including benefits, grievances, appeals, and external review processes.” • (919) 733-MCPA (6272) or toll free (866) 867-MCPA (6272) or via email @ MCPA@mail.jus.state.nc.us.