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