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Thread: Can anyone make sense of this???

  1. #1
    Join Date
    Apr 2007
    Lubbock, TX

    Thumbs down Cigna and PCP's/Specialists: Can anyone make sense of this???

    AAPC: Back to School
    We manage a variety of providers, including MD's, NP's, and PA's. We have each of them individually contracted with our payers, and they submit claims under their own rendering NPI's.

    The problem is with Cigna commercial - They will allow our MD's and NP's to be contracted as "PCP's", but not our PA's - they are considered "Specialists". The problem, here, is that a lot of patients' plans have higher copays and deductibles for "specialty visits", so they're penalized if they're seen by a PA in one of our clinics.

    I can't get anyone at Cigna to give me a logical explanation as to why a NP can be considered a PCP, but a PA can't. Neither one seems more qualified than the other for the title. Their website is absolutely no help, and neither are their provider service reps. I've even called provider relations, and the supervisor there gave me his best "guess", saying that normally, they don't even let NP's contract as PCP's, but a handful of states have laws that require them to, and so he believes that TX must be one of them. Has anyone ever dealt with this issue before? Is there really a law like that? I'm at my wit's end with this mightmare....Thanks!
    Last edited by btadlock1; 12-30-2010 at 12:53 PM.

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