APPEALS

LEVEL 1

• CALLS ELIGIBLE FOR APPEALS ARE CD OR DMR THAT HAVE BEEN DENIED OR PARTIALLY DENIED.

• PARTIAL DENIED IS WHEN A CUSTOMER IS REQUESTING A PARTICULAR DOSAGE, STRENTH OF A MEDICATION, PARTICULAR AMOUNT OF MONEY REFUNDED (DMR) AND RECEIVES A PORTION IS REQUESTED BUT NOT ALL THAT WAS REQUESTED.

• CUSTOMER IS UNABLE TO VIEW THE CD/DMR ON THE ACCOUNT. PROBE AND ASK THE CUSTOMER TO DETERMINE IF THEY HAVE RECEIVED A DENIEAL LETTER/PHONECALL STATING CIGNA HAS DENIED THEIR REQUEST

• OFFER TO TRANSFER THEM TO ESI APPEALS UNIT TO COMPLETE THE PROCESS ONCE DENIED COVERAGE DETERMINTAION IS VERIFIED.

EXPEDITE - 72 HRS STANDARD - 7 CALENDAR DAYS

LEVEL 2

• APPELAS ARE HADNLED BY INDEPENDENT REVIEW ENTITY > KNOWN AS C2C INNOVATIVE SOL. INC. HAS A CONTRACT WITH CMS AND HAS NO CONNECTION TO CIGNA HEALTHCARE. -IT CAN BE SUBMITTED VIA

ONLINE WWW.C2CINC.COM//APPELANT-SIGNUP PHONE 833 919 0198 MAIL C2C INN SOLUITIONS INC. PARTD DRUG RECONSIDERATIONS PO BOX 44166 JACKSONVILLE, FL 32231-4166 FAX -EXPEDITED 833 710 0579 -STANDARD 833 710 0580