Guide to the GWH-CIGNA Network - Secured Provider Portal for the ...

832193 c 06/11 

for health care professionals 

Guide to the GWH-CIGNA Network 

CIGNA maintains a separate network for individuals who have ID cards that include the GWH-CIGNA identifier in the upper 

right corner of the card. This network is referred to as the GWH-CIGNA network. 

There are some variations between GWH-CIGNA and the CIGNA network. This guide will help you understand when a 

patient is in-network, the claim and service channels, contractual relationships with ancillary vendors, Explanations of 

Payment (EOP), and Electronic Data Interchange (EDI) transactions. 

Providing In-Network Services 

When a patient presents the GWH-CIGNA ID card, 

you are in-network for that patient if: 

n your provider agreement identifies a Great-West Healthcare 

company; or 

n you have a provider agreement that identifies a Great- 

West Healthcare company and a separate agreement with 

Connecticut General Life Insurance Company or a CIGNA 

HealthCare HMO; 

n you have been notified in writing that individuals 

covered under plans formerly administered by Great- 

West Healthcare are now covered under your CIGNA 

participating provider agreement. 

Otherwise, you are an out-of-network health care professional 

for patients with GWH-CIGNA ID cards. 

When a patient presents the CIGNA ID card, you are 

in-network for that patient if: 

n you have a provider agreement with Connecticut General 

or a CIGNA HealthCare HMO. 

If you only have a provider agreement that identifies a former 

Great-West Healthcare company, you are an out-of-network 

health care professional for patients with a CIGNA ID card. 

myCIGNA.com 

CIGNA Health andLife InsuranceCompany 

Group 00699999 

Issuer (80840) 

ID 199500000 

Name John A Doe 

PCP None Selected 

No Referral Required 

Sample Company 

RxBIN 600428 RxPCN 05180000 

RxGrp 00699999 

RxID 199500000 00 

TPV Logo 

Connecticut General Life Insurance Co. 

IIN 600428 Control 00600000 

Account: 1234567 

Issuer (80840) 

Coverage Effective Date: 01-01-2010 

ID: 

U23456789 01 

Name: John Public 

PCP: John Smith 

PCP Phone: XXX-XXX-XXXX 

ABC Company 

Doc Name 

NETWORK 

SAVINGS PROGRAM 

LOGO 

Copays 

Primary Care $25 

Specialist $25 

UrgentCare $25 

ER $100 

® 

GWH-CIGNA 

Open Access Plus 

No Referral Required 

PCP Visit 10% 

Specialist 20% 

Hospital ER 20% 

Vision Yes 

Rx 30%/40%/50% 

Network Coinsurance: 

In 90%/10% 

Out 70%/30% 

Med/Rx Deductible Applies 

NMCWEBA

Network Differences 

Separate Claim and Service Channels 

It is important that the correct claim submission processes are followed for both the CIGNA and the 

GWH-CIGNA network. Currently, claim submission is different depending on the network. Follow the 

information found on the patient ID card, including: 

n Claim address and claim submission process 

n Payer ID number 

n Precertification procedures 

n Customer service number and web address 

For additional information, access the Important Contact Information found on the Secured Provider 

Portal, www.gwhcignaforhcp.com. 

Ancillary Vendor Relationships 

The GWH-CIGNA and CIGNA networks may have different contractual relationships with vendors such 

as radiology and laboratory. When you refer a patient with the GWH-CIGNA ID card for these services, use 

the Provider Directory and the CIGNA Reference Guide found on the Secured Provider Portal, 

www.gwhcignaforhcp.com to find an in-network vendor. 

EOPs and EDI Transactions 

The GWH-CIGNA identifier also appears on paper Explanation of Payment (EOP) documents and on 

Electronic Data Interchange (EDI) transactions. You can identify an EOP associated with a GWH-CIGNA ID 

card by the 1000 Great-West Drive claim address, the payer ID 80705, and the GWH-CIGNA remark code. EDI 

transactions associated with the GWH-CIGNA ID card will include the GWH-CIGNA identifier in the payer 

name field. 

Need more information? 

CIGNA 

www.cignaforhcp.com 

1.800.88CIGNA (882.4462) 

GWH-CIGNA 

www.gwhcignaforHCP.com 

1.866.494.2111 

“CIGNA” and the “Tree of Life” logo are registered service marks of CIGNA Intellectual Property, Inc., licensed for use by CIGNA Corporation 

and its operating subsidiaries. All products and services are provided exclusively by such operating subsidiaries and not by CIGNA 

Corporation. Such operating subsidiaries include Connecticut General Life Insurance Company (CGLIC), CIGNA Health and Life Insurance 

Company (CHLIC), and HMO or service company subsidiaries of CIGNA Health Corporation and CIGNA Dental Health, Inc. CGLIC may also 

administer insurance policies and self-insured plans on behalf of Great-West Life & Annuity Insurance Company and its affiliates, First 

Great-West Life & Annuity Insurance Company, White Plains, N.Y., and Canada Life Assurance Company, as well as The New England Life 

Insurance Company and Metropolitan Life Insurance Company. 

832193 c 06/11 © 2011 CIGNA

Guide to the GWH-CIGNA Network - Secured Provider Portal for the ...

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