Monthly Billing Statement

Transcription

1 Monthly Billing Statement Sample Invoice and User s Guide Cat. #591797a 9/ CIGNA

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3 CIGNA HealthCare Monthly Billing Statement This guide introduces our Monthly Billing Statement. The principle features of the invoice are described, including examples of the following pages: Voucher Page Monthly Summary Summary of Account Activity Summary of Current Costs Account Level Summary of Current Costs Adjustments Summary of Eligibility Updates Processed Adjustments of Client Reported Lives/Volume Changes Adjustments Summary of Retroactive Billing Line Changes Current Subscribers Eligibility Updates Processed Each month, we will mail your billing package on the Normal Bill Day you selected when you established your profile with us. If you find that this date does not suit your needs, we can change your Normal Bill Day to another date that is more convenient for you. If you have two or more billing locations (or if you have asked us to split up your billing for other reasons) we will send you two or more billing packages each month. Each billing package will be identified by its own statement number. Occasionally we may need to notify you of changes for prior months. For example, this will occur when you have retroactive changes to eligibility or structure. If you have any questions regarding your billing package, please do not hesitate to contact your Employer Services Consultant, whose contact information is on your invoice. Thank you again for choosing CIGNA HealthCare a 9/ CIGNA Sample Invoice & User s Guide 9/2005 1

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5 Sample Invoice & User s Guide TABLE OF CONTENTS Voucher Page Description Voucher Sample Monthly Summary Page Description Monthly Summary Sample Summary of Account Activity Page Description Summary of Account Activity Sample Summary of Current Costs Page Description Summary of Current Costs Sample Account Level Summary of Current Costs Page Description Account Level Summary of Current Costs Sample Adjustments Summary of Eligibility Updates Processed Sample Adjustments of Client Reported Lives/Volume Changes Sample Adjustments Summary of Retroactive Billing Line Changes Sample Current Subscribers Sample Eligibility Updates Processed Page Description Eligibility Updates Processed Sample Sample Invoice & User s Guide 9/2005 3

6 Voucher Page (Section 1 of Your Bill) The first page of each invoice is a voucher page, which should be used when you submit your monthly payment to the appropriate lockbox. This page refl ects the following: Indicates your CIGNA HealthCare billing contact with mailing address and address. Contains your client identification number. The statement number will identify which invoice this is, if you have requested CIGNA HealthCare to split the billing into two or more invoices. Contains the invoice number. This invoice number is an auto- and sequentiallygenerated unique number that can be used to identify a specific invoice. Indicates the month represented by the invoice. This is the date the invoice was printed. The bill will include all billing activity up to this issue date. This is the date payment is due to be remitted to CIGNA HealthCare for the invoice; considered to be delinquent if payment is not received by the last day of the month. This section will only appear if your invoice contains volume coverages that require you to fill in the open boxes on your invoice. This sentence is a reminder to return those completed pages of your invoice with your payment. The bottom section of the voucher page should be mailed to the lockbox with payment. Indicates the month represented by the invoice. Please write in the number that is printed under the heading Amount Due for Reported Months on your monthly summary page. (Item O on page 7 of this user s guide.) Please repeat the number that you placed in the box labeled Client Reported Amount Due on your monthly summary page. (Item P on page 7 of this user s guide.) This total should be the same as the Total Amount Due on your monthly summary page. (Item R on page 7 of this user s guide.) Lockbox address where payment should be mailed. 4 Sample Invoice & User s Guide 9/2005

7 Sample of Voucher All samples used are for illustrative purposes only. Your invoice may differ in size, funding type combinations, structure, number of pages, etc., based on your specifi c information. Sample Invoice & User s Guide 9/2005 5

8 Monthly Summary (Section 2 of Your Bill) This page of each invoice is a Monthly Summary, which shows the billing activity that has taken place since the previous month s invoice was issued. This page shows: The amount due that you reported during the past month for your volume coverages. Payments received. Any adjustments to the reported amount due for earlier months. The resulting balance due for the reported months. The Monthly Summary provides a current status of the account and a summary of the billing activity during the month. If you have purchased volume coverages, space is provided on the Monthly Summary for you to enter the total amount due and the amount of payment required for the invoice. Represents the account numbers associated with the invoice. Balance due from the prior month s invoice. Summarizes the data you reported for previous months, for volume coverages (D + E). These are the amounts you reported, by month, for volume coverages. These are the adjustments you reported for prior months. Grand total of all payments received since previous invoice. If multiple payments are received, they will be listed with receipt date. Due from the prior invoice plus any current reported amounts due, (including adjustments) less payments issued. (B +/- C - F) Total amount of billed charges for the month. The total adjustment amount calculated for prior months. - Represents adjustments processed for the invoice by adjustment type. Indicates any late payment charges due (ASO Only). Totals Current Costs +/- Adjustments + Late Payment Charge. (I +/- J + N) Space is provided for you to indicate the amounts due for volume coverages. Our estimate of the amount due for this month based on your previously reported data. Please write in the total amount due, which equals the payment required (O + P). If you have purchased volume coverages, this message will appear if we have not received all the reported amounts required for the indicated month(s). Billing contact name and phone number. 6 Sample Invoice & User s Guide 9/2005

9 Sample of Monthly Summary Page.. All samples used are for illustrative purposes only. Your invoice may differ in size, funding type combinations, structure, number of pages, etc., based on your specifi c information. Sample Invoice & User s Guide 9/2005 7

10 Summary of Account Activity (Section 3 of Your Bill) This section of the bill is an OPTIONAL tool for your use in identifying Summary of Account Activity by account number, funding arrangement type, and by the total amounts due for the month. We can suppress the printing of this section upon request. This section represents a summary of account activity for a billing period. There are three funding types and this section summarizes monthly totals by funding type. The funding types are: 1. Insured If CIGNA HealthCare HMO coverage has been purchased, it will be shown, for billing purposes only, with this funding type. 2. ASO Administrative Services Only 3. MP Minimum Premium/AEB This column reflects the current monthly cost for those benefits that are billed based on the eligibility data you have given us. This column reflects the total adjustments by funding type. Amount due. This column represents the totals that you reported for volume coverages. Account total. This column represents the amount you reported for volume coverages. Demonstrates the break-out of Summary of Account Activity by Account Number. This is our estimate of the amount due for this month based on the client s previously reported month s data. Grand totals for all account numbers broken down by funding arrangement type. Late payment charges on ASO only. 8 Sample Invoice & User s Guide 9/2005

11 Sample of Account Activity All samples used are for illustrative purposes only. Your invoice may differ in size, funding type combinations, structure, number of pages, etc., based on your specifi c information. Sample Invoice & User s Guide 9/2005 9

12 Summary of Current Costs (Section 4 of Your Bill) This section of the invoice IS PROVIDED when you have purchased volume coverages. It is RECOMMENDED when there are charges from claim or other sources associated with ASO funding that are not captured elsewhere. It IS OPTIONAL in all other situations. This section refl ects the detail by account, by branch, and benefit option with the amounts due for the coverage month. Account Number if you have multiple account numbers, separate current costs sections will be produced. Current Costs plus month of invoice. All billing lines associated with the account and the branch are listed. If network/party billing is applicable, network/ party names appears in this section. Funding type code appears in this section. (I = Insured, A= ASO, M = Minimum Premium/AEB) Rate Tier (e.g. Emp, Emp + Spouse, Emp + Family = Tier 1, 2, 3, etc.) If a box is provided, please insert correct amount for volume coverage. For the eligibility based billing lines the lives are automatically populated. If a box is provided, please insert correct amount for volume coverage. Month represented by the data. Script and Service Line data contain a lag in reporting due to availability of information. For Current bill type there is a one-month lag since the bill is released during the month of service. There is a two-month lag on Prior month bill types, since the bill is released prior to the month of service. Billing rate associated with each benefit. Rate basis associated with each benefit (e.g. per emp, per 1000, etc.) If a box is provided, please insert correct amount for volume coverage. For all other billing lines, the amount due is automatically calculated. Branch number and name. Estimated information based on your previous month s reporting. If a box is provided, please insert total of all entries in column L. Please insert total of any adjustments you are reporting for this invoice. Please insert total of items O + P. For illustration purposes only. We have the ability to bill at non-composite rate and composite rate level. This wording will not appear on the bill. Amount due for emp/dep rate basis. Amount due for non-emp/dep rate bases (e.g. per service line, per script, etc.) Branch total due for eligibility based and manually closed lines. (S + T) Special charges are located in this section. Total amount due for special charges for specified account and branch number. 10 Sample Invoice & User s Guide 9/2005

13 Sample of Current Costs All samples used are for illustrative purposes only. Your invoice may differ in size, funding type combinations, structure, number of pages, etc., based on your specifi c information. Sample Invoice & User s Guide 9/

14 Account Level Summary of Current Costs (Section 5 of Your Bill) This page represents a summary of current costs for each branch by account number, and will be produced if the Current Costs section of the invoice is included in the monthly billing package, or if you have more than one account number. Represents the account number for which the Summary of Current Costs is detailed. Summary of the amounts you have reported for the specified branch. Summary of the eligibility-based and manually-closed amounts due for the specified branch. B + C. Specified Branch. This is our estimate of the amount due for this month based on your previously reported data. Total of the branch level reported totals listed above. Grand total of all branch level charges listed above. Note: If all billing lines are pre-populated before the invoice is released, this page will contain totals with no manual action required. 12 Sample Invoice & User s Guide 9/2005

15 Sample of Current Costs Account Level Summary All samples used are for illustrative purposes only. Your invoice may differ in size, funding type combinations, structure, number of pages, etc., based on your specifi c information. Sample Invoice & User s Guide 9/

16 Adjustments Summary of Eligibility Updates Processed (Section 6 of Your Bill) This section of the invoice IS OPTIONAL. We can suppress the printing of this section upon request. When selected, this section will refl ect a summary of eligibility adjustments processed by billing line that were eligibility-based billed and the applicable month of adjustment. Sample of Adjustments Summary of Eligibility Updates Processed All samples used are for illustrative purposes only. Your invoice may differ in size, funding type combinations, structure, number of pages, etc., based on your specifi c information. 14 Sample Invoice & User s Guide 9/2005

17 Adjustments of Client Reported Lives/Volume Changes (Section 7 of Your Bill) This page of the invoice IS OPTIONAL. We can suppress the printing of this section upon request. When selected, this section will refl ect changes to lives and/or volume on the open billing lines that you have reported to us. Month Adjusted Billing Line Changed Funding Basis Old Lives/New Lives Old Volume/New Volume Rate and Rate Basis Amount Due Sample of Adjustments of Client Reported Lives/Volume Changes All samples used are for illustrative purposes only. Your invoice may differ in size, funding type combinations, structure, number of pages, etc., based on your specifi c information. Sample Invoice & User s Guide 9/

18 Adjustments Summary of Retroactive Billing Line Changes (Section 8 of Your Bill) This page of the invoice IS OPTIONAL. We can suppress the printing of this section upon request. When selected, this page represents all retroactive billing line changes to all billing lines. The page will refl ect: Month Changes Occurred Billing Line Description Network/Party Name Funding Basis Tier Old Lives/New Lives Old Volume/New Volume Old Rate/New Rate Rate Basis Amount Due Adjustments Summary of Retroactive Billing Line Changes All samples used are for illustrative purposes only. Your invoice may differ in size, funding type combinations, structure, number of pages, etc., based on your specifi c information. 16 Sample Invoice & User s Guide 9/2005

19 Current Subscribers (Section 9 of Your Bill) This page of the invoice IS OPTIONAL. We can suppress the printing of this section upon request. When selected, this section of the bill refl ects current subscribers on the current month invoice. The fields of information provided are: Branch Number Billing Line Description of Charges Per Subscriber Rate Tier Amount Due Subscriber Name Network/Party Name Month Subscriber Employee ID Number Funding Basis Applicable to Each Benefit Rate Basis Sample of Current Subscribers (not available for Summary bills) All samples used are for illustrative purposes only. Your invoice may differ in size, funding type combinations, structure, number of pages, etc., based on your specifi c information. Sample Invoice & User s Guide 9/

20 Eligibility Updates Processed (Section 10 of Your Bill) This page of the invoice IS OPTIONAL. We can suppress the printing of this section upon request. When selected, this section of the invoice refl ects all eligibility updates processed during the period identified by subscriber. This section contains the same information as page 14 of the bill with the exception of the following: Reason effective date the date of the change. Reason this field will indicate if the change was an addition, termination or reinstatement. 18 Sample Invoice & User s Guide 9/2005

21 Sample of Eligibility Updates Processed (not available for Summary bills) All samples used are for illustrative purposes only. Your invoice may differ in size, funding type combinations, structure, number of pages, etc., based on your specifi c information. Sample Invoice & User s Guide 9/

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24 All samples used are for illustrative purposes only. Your invoice may differ in size, funding type combinations, structure, number of pages, etc., based on your specific information. CIGNA HealthCare refers to various operating subsidiaries of CIGNA Corporation. Products and services are provided by these subsidiaries and not by CIGNA Corporation. These subsidiaries include Connecticut General Life Insurance Company, Tel-Drug, Inc. and its affi liates, CIGNA Behavioral Health, Inc., Intracorp, and HMO or service company subsidiaries of CIGNA Health Corporation and CIGNA Dental Health, Inc. In Arizona, HMO Plans are offered by CIGNA HealthCare of Arizona, Inc. In California, HMO plans are offered by CIGNA HealthCare of California, Inc. In Virginia, HMO plans are offered by CIGNA HealthCare of Virginia, Inc. and CIGNA HealthCare Mid-Atlantic, Inc. In North Carolina, HMO plans are offered by CIGNA HealthCare of North Carolina, Inc. All other medical plans in these states are insured or administered by Connecticut General Life Insurance Company. 22 Cat. #591797a 9/ CIGNA Sample Invoice & User s Guide 9/2005