Cigna Providers Outside a Kaiser Permanente State (Outside CA, CO, DC, GA, HI, MD, OR, VA, WA)

REQUIREMENTS: - Immediately: Billing team must update claim submission and collection protocols for Kaiser Permanente members presenting Cigna Healthcare-branded Travel Cards or co-branded membership cards indicating KP plan participation when treated outside Kaiser Permanente states (outside CA, CO, DC, GA, HI, MD, OR, VA, WA). - By next billing cycle: Update front desk and collection staff to recognize which KP plan types require upfront cost-sharing collection vs. post-claim processing: (1) KP 3-Tier POS members—collect applicable cost-sharing at time of service; (2) KPIC PPO members—collect applicable cost-sharing at time of service; (3) KP HMO, EPO, POS 2-Tier members—DO NOT collect payment at time of service; bill Cigna/KP after claim pricing. - Verify eligibility: Confirm members are NOT enrolled in Medicare, Medicaid (Medi-Cal), or Washington situs coverage (Kaiser Foundation Health Plan of Washington, Kaiser Foundation Health Plan of Washington Options, Inc., or Washington situs PPO/3-Tier POS issued by Kaiser Foundation Health Plan of Northwest) before applying this network. - Update billing system: Route claims for eligible KP members treated outside KP states through Cigna Healthcare PPO network billing pathway, not regional/national legacy processes. - Document in patient record: Note when services are provided under Cigna Healthcare PPO network access for KP out-of-state travel to ensure proper claim routing. - Failure to correctly identify eligible members and apply appropriate collection rules may result in improper patient balance collection, claim denials, or compliance issues with KP contracting terms.