Verifying Eligibility and Submitting Claims for Better Health Plan Members

When treating a patient whose member ID card features both the Better Health Plan and Cigna logos, please note that this is a self-funded plan administered by Better Health Plan. Cigna provides the network access, while Better Health Plan handles all administrative functions, including eligibility verification, utilization management, and claims processing.

To ensure seamless administrative processing and prevent claim delays, please utilize the guidelines below.

Plan Structure Breakdown

• The Administrator (Better Health Plan): Better Health Plan is the Third-Party Administrator (TPA). All administrative inquiries, eligibility checks, and claims routing must go through Better Health Plan.
• The Network (Cigna): Cigna provides the PPO network access and contracted discount rates only. Cigna does not hold enrollment data, manage benefits, or adjudicate claims for these members.
• "Not Insured by Cigna" Notice: Member ID cards feature this standard legal disclaimer to indicate that while Cigna network rates apply, Better Health Plan is the designated administrator responsible for funding and processing.

Important: Attempting to verify eligibility or submit claims through the Cigna provider portal or Cigna customer service will result in an "Error" or "Member Not Found" notification.

1. Eligibility & Benefits Verification

Do not contact Cigna to verify member benefits. Please contact Better Health Plan directly via the following dedicated provider channels:

• By Phone: (866) 881-0676, Option 2 (Available Monday – Friday, 8:30 AM – 5:30 PM EST)
• By Email: providers@betterhealthplan.com

2. Claims Submission Guidelines

All medical claims must be submitted directly to Better Health Plan for adjudication and payment. Please route claims using the information below:

Provider Support

If your office encounters issues during eligibility verification or the claims process, please contact our Provider Services department at (866) 881-0676, Option 2 for immediate assistance.