Cigna recently decided it will not transition its commercial customers to the RxClaim processing platform. Accordingly, the 15 Cigna commercial clients currently on RxClaim will transition to Argus as of June 1, 2015.

Cigna Commercial Clients

Cigna recently decided it will not transition its commercial customers to the RxClaim processing platform. Accordingly, the 15 Cigna commercial clients currently on RxClaim will transition to Argus as of June 1, 2015.

Cigna-HealthSpring currently utilizes a clinical program which is designed to review a member’s prescription history for possible drug related concerns. The goal is to improve the quality and cost effectiveness of dispensed medications by ensuring adjudicated prescriptions are clinically appropriate. The edits in place can be easily overridden by using the appropriate DUR/PPS Reason and Result codes found below. This edit assesses the total daily dose based on FDA approved maximum dosing information. The edit identifies single incoming claims of concern as well as overlapping claims with the member’s history based on specific ingredients. The edit will be triggered if the total daily dose exceeds the FDA-defined maximum daily dose.

Pharmacy claims processing for Cigna customers is being gradually moved to the Catamaran RxClaim Platform. As of March 1, an additional 261 Cigna clients, representing approximately 39,000 customers, will transition to RxClaim.

A full list of all Cigna clients that will be on RxClaim as of March 1, 2015 can be found on the Catamaran provider portal. If you have access, please log in at www.catamaranrx.com/pharmacies to view the list under Pharmacy Information. If you do not have access to the portal, send an email to Provider.relations@catamaranrx.com to request the list. You will receive a response within 24 hours. Put "Cigna March 1 Client List" in the subject line of the email.