Yuzu is a Third-Party Administrator (TPA), we do not hold or even have access to network contracts for Cigna. The below diagram of claims processing describes our role in processing claims within Cigna claims.
Diagram
See below for an overview of each of the steps in the diagram.
(A) Member insurance information is generally put into a provider EHR system. Different insurance systems will have different ways of building “Insurance Coverage” objects, but generally these will require:
Member ID: See ID Card schematic below
Electronic Payer ID: Always use 62308
Claims address: Always use PO Box 188061, Chattanooga TN 37422
Member name: See ID Card schematic below
(B) Claims sent to Cigna’s electronic payer ID are typically received within 24 hours of send by Cigna and are priced within 24 hours later.
(C) Claims sent via mail are typically received within 3-5 days, with an additional 2-3 days of processing time for scanning those claims. Yuzu does not have visibility into Cigna’s mailroom.
(D) Cigna makes pricing and network status determinations within their own systems based primarily on the TIN and NPI on the claim.
(E) Cigna sends the priced claim to Yuzu. Yuzu loads this priced claim and it can be immediately viewed (even if it is in a processing state) within Yuzu’s provider portal.
You can check claim status by following instructions here without making an account. If you have an account, you can see all of your claims by following these instructions.
(F) Yuzu sends payment and an EOP to the provider. By default, this is sent in the mail as a check, however we support signing up for zero-cost electronic remittances (see here for instructions).
FAQs
Question | Answer |
|---|---|
Who should I put as the “Insurance”? | You should put the name of the health plan, which is generally neither Yuzu nor Cigna but one of our Health Plan partners identified by the Logo on the card. Legally speaking, the “insurance” is the employer that the member works for. |
Can I send my claim directly to Yuzu? | No, Cigna requires that claims be sent to their claims address. |
I’d like to make a Single Case Agreement with you for my patient. How do I do this? | Cigna has terms in their contract with employers that make it very difficult to do direct contracting in most situations. You may reach out to support@yuzu.health with your request, but depending on the specific employer plan, Yuzu may or may not be able to create a direct contract (including SCAs) in a plan with the Cigna network. |
I would like to complain about not being paid faster. | Yuzu is responsible for paying claims, although we do so with employer funds. Oftentimes claims delays are related to delays in filing reinsurance claims with the employer’s stoploss carrier. |
Which Cigna network are you? | Yuzu rents the Shared Administration PPO network. If you are contracted with the Cigna network in any way, you are likely contracted with the Cigna Shared Administration PPO. |