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Life Health > Health Insurance

UPDATED: N.J. Officials Criticize CIGNA HMO

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NU Online News Service, May 10, 4:05 p.m. – The New Jersey Department of Banking and Insurance says a unit of CIGNA Corp., Philadelphia, did a poor job of complying with the state’s claims-processing requirements in 2000.

New Jersey law requires state-regulated health plans to pay properly completed electronic claims within 30 days of receipt, and properly completed paper claims within 40 days.

When New Jersey department examiners reviewed claims filed in 2000 by members of CIGNA Health Care of New Jersey, a health maintenance organization, they found that CIGNA Health Care paid about 10% of the legitimate claims it received late.

CIGNA Health Care violated the prompt-payment guidelines only 2% of the time when it handled claims itself, but the company’s subcontractors violated the rules 26% of the time, the New Jersey department says.

The examiners also found that the subcontractors had trouble notifying patients and providers about claims denials. CIGNA itself violated the notification requirements only 2% of the time, but the subcontractors violated the requirements 41% of the time, the New Jersey department says.

The New Jersey department also suggests that CIGNA Health Care had inadequate safeguards to prevent claims from being lost.

When examiners looked for 66 claims cited in complaint letters, CIGNA Health Care could provide only 36, the department says.

CIGNA put out a statement noting that the company processed more than 750,000 claims during the period examined.

CIGNA itself processed 90% of the claims it handled on time, and 98% of the claims it handled correctly, the company says.

“The remaining claims were processed by vendors,” CIGNA says. “Since 2000, we have taken measures to better manage vendor performance, including implementing internal workflows and improved oversight. In late 2000, we began systematically paying interest on all late claims. We believe we are currently in compliance with applicable New Jersey claims payment laws.”


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