CIGNA Health Care of North Carolina recently mailed a notice to providers stating that as of August 1, 2012, the timeframe to submit claims for reimbursement will change to 90 days from the date of service, except where a different timeframe is required by state law. Where CIGNA is a secondary payor, the notice states the timely filing deadline is 90 days from the date that the practice receives the explanation of payment from the primary payor.

North Carolina state law requires health plans to give practices at least 180 days to file claims. However, that state law only applies to claims that you file to fully-insured, commercial health plans that are subject to North Carolina’s insurance regulations. The 180-day requirement does not apply to self-funded health plans, even when CIGNA, Aetna, or BCBSNC handles the administration of those self-funded health plans.

Until now, CIGNA has been accepting all claims in accordance with North Carolina’s 180-day minimum, without regard to whether the plan was self-insured or fully-insured. North Carolina is one of the last states in the country that CIGNA has not already converted to a 90-day timely-filing requirement for claims filed against self-insured plans. Pressure from employer groups across the country was cited as the primary reason for the change.

The proposed change essentially creates two separate timelines for filing claims to CIGNA. First, you would be required to file claims within 90 days against self-funded plans that CIGNA administers; i.e., where CIGNA handles administrative services only for that plan.  For fully-insured CIGNA plans, the more generous, state-required 180-day filing window still applies.

Unfortunately, a 90-day timely filing requirement for self-insured plans is not new in North Carolina or unique to CIGNA. Several other major self-insured health plans and third-party administrators in North Carolina have already shortened the filing window. Patient insurance cards should inform medical practices whether a plan is self-insured or fully-insured, allowing them to identify the applicable filing period.

You can object to the proposal.  In its notice, CIGNA provided a specific contact and instructions for submitting written objections. CIGNA has told the NCMS that objections will be reviewed and decided upon a case-by-case basis.