1. Portfolio Management Business Impact Assessment
Autonomic Nervous System Testing
Business Impact Assessment
Proposal Type: Full Scale
Date: 06/25/2014
Project Sponsors: David Finley, MD
Business Lead: Dr. Julie Kessel
Presenter: Robb Coutinho
BPMS ID: 13049
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2. Overview/Background Information
• Autonomic nervous system (ANS) testing is performed on individuals with specific symptoms to
help diagnose & manage autonomic nervous system dysfunction. CPU will develop and post a
coverage policy and implement CPT codes 95921, 95922, 95923, 95924, 95943 using a PXDX edit.
ANS testing will be COVERED for specific medically necessary diagnosis codes and DENIED as
EIU for all other codes.
• These tests are PROVEN useful to diagnose some conditions; and is UNPROVEN for other
diagnoses. In many conditions testing is not clinically useful.
• Estimated Annual Total Medical Cost Savings: $2.4M
• Estimated Annual Service Denials: 17,870
• Estimated Average Cost per Service: $143
• Medical necessity appeal rights will be issued
• Competitive Landscape: All competitors who have policies agree. Neurological societies agree:
American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic
Medicine
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3. Idea/Concept Name
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• The CPU seeks to develop a medical coverage policy for Autonomic
Nervous System Testing. This initiative seeks deny CPT codes 95921,
95922, 92923, 95924 and 95943 in ClaimsXten via a dictionary update
to the MP_PXDX_PROF rule.
WHAT
• Target Date: 02/16/2015
• Neurologists, Cardiologists, Internal Medicine, Pediatricians
• No Vendor Impacts
• These tests are PROVEN useful to diagnose some conditions; and
UNPROVEN for other diagnoses. In many conditions testing is not
clinically useful.
• Estimated Annual TMC = $2.4M
WHY
WHEN
WHO
HOW
• Implementation Lever: Dictionary update to the MP_PXDX_PROF rule
using ClaimsXten.

4. Autonomic Nervous System
Testing
Annualized TMC =
$2.4M
Unit cost per denied
claim = $143
# claims to be denied =
17,870
1,249 unique HCPs
denied
88% par utilization 8,876 Unique customers denied
Codes 95921: Cardiovagal function testing
95922: Vasomotor function testing
95923: Sudomotor function testing
95924: Autonomic function, combined testing, with passive
tilt
95943: Simultaneous function testing, head-up posture
Vendor No Vendor Impacts
Specialties impacted Neurologists, Cardiologists, Internal Medicine, Pediatricians
Annualized
Impacts
What is Autonomic Nervous System (ANS) Testing?
• The autonomic nervous system controls how our organs work.
• Autonomic nervous system testing is performed on individuals with specific signs
and symptoms to help diagnose & manage autonomic nervous system dysfunction.
• These tests are PROVEN useful to diagnose some conditions; and is UNPROVEN
for other diagnoses. In many conditions testing is not clinically useful.
What is happening now?
• Coverage policy is under development.
• The CPT codes are not implemented and pay for all conditions without review.
What is changing?
• CPU will develop and post a coverage policy and implement the codes using a
PXDX edit.
• Autonomic nervous system testing (95921, 95922, 95923, 95924, 95943) will be
COVERED for specific diagnosis codes listed a medically necessary and DENIED
as EIU for all other diagnosis codes.
• Medical necessity appeal rights will be maintained. American Academy of Neurology
American Association of Neuromuscular and
Electrodiagnostic Medicine
Aetna, AmeriHealth Caritas
(Medicaid) Anthem, Blue Cross
Blue Shield Mississippi, First
Coast Service Options (CMS
Regional Carrier)
None found

5. Scope
 PHS and PHS+
 Impacted claim platforms in scope: PMHS, Proclaim, Facets
 Impacted Product Families? Medical
 Impacted Product Types: PPO, OAP, Select, Managed Care (all products)
 Impacted Market Segments: Select, Regional and National
 Applicable to all states? All States
 A national provider contract: N/A
 Neurologists, Cardiologists, Internal Medicine, Pediatricians
 Non-par providers
 Communications: Date for sending: 11/15/2014; 1,109 HCP letters (Figure includes Top 10 Non-Par
HCPs)
 TPVs: Out of scope
 CGHB: Out of scope
 ID card changes: No ID cards will be reissued
 On-Line or Paper HCP Directory Updates Needed: No
 CareAllies: Out of Scope
 Behavioral: Out of Scope
 UB-04: Out of Scope
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5

6. Claim-Customer-HCP Volumes
6
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Claims Volumes
Number of Claims/Services 17,870
Number/% Par 88%
Number/% Non-Par 12%
Number of Denied Claims/Services
Avg. Cost of Service $143
Estimated Appeal Volume (Based on previous or similar experience)
894 (5% appeal rate
assumption)
HealthCare Professionals (HCPs)
Number/% Par 1,099
Number/% Non-Par 150
Number of HCPs broken down by Provider Type (FA, AN, PR, AS)
N/A
Number of Letters to HCPs* (if applicable)/Target mailing date?
1,109* (11/15/2014)
*Figure includes Top 10 Non-
Par HCPs
**If HCP letters are required will they just be sent to impacted HCP’s or a broader group of HCP’s?
Customers
Unique # of Impacted Customers* 8,876
Number of Letters to Customers* (if applicable)/Target mailing date?
N/A
*i.e. Customer disruption due to network change
*Indicate how this number was determined: i.e. expected based on current claims, over the lifetime of initiative,
based on next year's assumptions, etc.

7. Cost Benefit Analysis
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Question Answer and Additional
Clarification
What are the proposed savings? Estimated TMC savings of $2.4M
Cigna Earnings Impact of $360K
What are the assumptions used for the development of savings?
Estimated annual denials = 17,870
Average cost = $143
Denial Volume Breakdown: (17,870)
Proclaim: 14,653
PMHS: 1,787
Facets: 1,430
Are there any cost assumptions? Will need cost estimates from the following:
Service Operations (Call, Claim, Appeal, CA/CAT)
PBAB
Sales Effectiveness
HCP Communications
Prepay
Medical Management
Has Medical Economics signed off on benefits? Yes

8. High Level Implementation Plan/Program Components
Ensure Coverage Policy Updates Have Sign-off with Matrix Partners
• Work with Prepay to complete the Intake form, query development, testing, and approval so claims can
be ‘batched’ and sent to Medical Director for review
• Work with Medical Management & Prepay to update Medical Necessity Denial letters if applicable.
• Work with Legal and Compliance to ensure any state exceptions are properly implemented
Provide Coverage Policy Coding Changes
• The Coverage Policy Unit will develop the Autonomic Nervous System Testing coverage policy
• Provide updated coverage policy coding to Implementation Team
• The Change Request Authorizations will have to be supplied to McKesson by January 1, 2015 for the
updates to take effect in ClaimsXten on February 16, 2015 release date
• Implementation Leads will ensure information is coded into the system accurately.
Update Standard Operating Procedures and Talking Points and Training
• Notify CSAs and Appeals/Claim Processors that Cigna will be enforcing this policy
• Provide the necessary information for Service Operations to update any talking points, scripts, and
standard operating procedures (if needed)
Develop a Communication Plan
• Develop an external communication for customers and HCPs
• Develop an internal communication for sales team and call center representatives
• Assuming a 90-Day Notification period before policy goes live
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9. Customer Experience Impact
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Question Answer/Additional
Clarification
Will this initiative increase Dr./Hospital/Clinic/Pharmacy choices, reduce it or
have no effect?
No Impact
Will customers have to change Dr./Hospital/Clinic/Pharmacy as a result of this
initiative? If yes, please explain.
No Impact
Will customers be denied claims that were previously accepted? If yes, please
explain.
Yes. Customers could see claim denials for Autonomic
Nervous System Testing (CPT codes 95921, 95922,
92923, 95924 and 95943)
Will customers see any reduced or increased out of pocket costs? Yes, a potential for increased out of pocket costs if
non-participating HCPs are utilized.
When and how will customers become aware of any changes to their
coverage?
No coverage changes.
Will this create a negative customer experience? Yes
Note: Annualized estimated impact = 8K customers
Will this have a significant impact (positive or negative) on customer loyalty
(i.e. likelihood of the customer to recommend Cigna)?
TBD
If a vendor is involved what will the vendor’s responsibilities include? No Vendor Impacts
1. Will the vendor outreach directly to the customer (email, letters, phone,
etc.)?
N/A
2. Will that outreach look and feel like it’s coming from Cigna or the vendor? N/A
3. Will the customer outreach directly to the vendor (phone, web, etc.)? N/A
4. Will the vendor act and feel like Cigna? N/A
5. If the customer calls Cigna but should have called the vendor, will the N/A

10. Sales / Client Experience Impact
Question Answer/Additional Clarification
# of impacted Clients & # of Claims including Customer & dollar impact) (Sales to
determine criteria as to when a Client list is required, may include at least a 12
month look back )
1,911
Client/Sales risks or impacts to Customers? Balance billing from Non-Participating HCPs
Will this create a negative client experience? Yes
Will letters need to be sent to Clients? If yes, who will receive letters, when, and the
volume?
None are planned as part of the project proposal
When creating new programs/pilots, would the client be able to “opt out” of the
program or pilot? If so, who would be responsible for that opt out process and what
criteria will Sales need to submit? Where will the opt out information be stored and
accessed by internal partners (e.g. Benefit Access)?
Exception requests will be considered on a one by one
basis.
Market Segment Specific impacts? All Segments
Vertical impacts? (Hospital, Government & Education verticals) Could this project
impact the special vertical needs of each of those markets.
N/A
Impacts to SBCs (summary of benefits & coverage), SPDs (summary plan
descriptions) and Benefit Summaries?
N/A
What’s the TMC, ROI, What is the ROI for the client and is there a need for a Sales
Talking Points ? cost or outcome driving the need for this change to Sales?
The CPU will partner with Sales Effectiveness to
provide talking points
Is there a cost that will be charged to the Client? Will the client see new Banking
info, line items? (e.g. billed charge; bank charge) If yes, what is the benefit the Client
can expect? Why is this change needed? (Client return)
N/A
Impacts to Contracts or ASO agreements? N/A
Can this proposal be incorporated into on-renewal experience? If not, why? N/A
Reporting Needs - Who will own reporting? Who would own report requests? Medical Economics will track ROI
If it’s a new plan or plan based change when are new plans effective? When are
enrollments slated to occur?
N/A
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11. Other potential topics to include
See the pre-IA Questionnaire at end of this presentation for a complete listing of potential impacts
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Question Answer/Additional Clarification
Impact to Product team? Can Product support the request? No Impact
If vendor is involved provide contract progress to date, vendor
responsibilities, contractor, etc. and has a contract been signed? If not, is
there a letter of intent?
N/A
Are there any online services required? N/A
Are specific Cigna coverage policies impacted? If so, what are they? Does
the Cigna policy support the actions of the vendor? If not, is a reconciliation
underway that includes Dx and Px codes?
The Coverage Policy Unit will develop a coverage policy for
Autonomic Nervous System Testing
Are there regulatory and compliances issues identified for the specific states
or accrediting organizations?
Compliance considerations are under review (Emily Pickering)
Will the change impact any claim processes If so, how? N/A
Are there current and/or requested prepay edits/processes or macros
impacted? If so, provide example/detail.
No
Will the change impact the pre-cert process? If so, how? N/A
What types of non-standard requests could be anticipated with the result of
the project or process improvement implementation? How many?
TBD
When creating new programs/pilots, would the client be able to “opt out” of
the program or pilot? If so, who would be responsible for that opt out process
and what criteria will Sales need to opt out of a program/pilot?
N/A

12. Links
 BPMS 13049
 IA Working Folder
 Autonomic Nervous System Testing Client/HCP Detail
 IA Response Form
 Kickoff & Deep Dive meeting minutes Meeting minutes
 Supporting Documentation:
 IT/BA Enterprise Architecture Guidance (if applicable)
12Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2014 Cigna

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