GENERAL UPDATE

Eligibility and Benefit Enhancements

CIGNA received the CAQH^® Committee on Operating Rules for Information Exchange^® (CORE) Phase I health plan certification in April 2010. Throughout 2010 and into 2011, CIGNA has continued to make enhancements to expand the plans that return a CORE Phase I-compliant eligibility and benefit response. CIGNA now supports a CORE Phase I-compliant response for all medical and dental plans, including GWH-CIGNA networks, CIGNA International Expatriate Business, CIGNA Medicare Advantage HMO in Arizona, CIGNA Voluntary, and CIGNA Behavioral Health. 

The CORE objectives are to generate cost savings, promote the adoption of a single set of rules and enhance interoperability in health care. In order to achieve these objectives, the CORE rules include both infrastructure and data content requirements that assist with securely streamlining electronic patient data exchanges across the wide range of current information technology systems. The objectives of CORE align with CIGNA’s strategy to continue to reduce the complexity of doing business with us and help eliminate administrative work.

CIGNA CORE Phase I certification enhancements include implementing the 270/271 eligibility and benefit transaction for the CIGNA Voluntary and Medicare Advantage HMO plans.

Enhancements to the data content of CIGNA's 270/271 may affect the information presented through your clearinghouse or vendor. These changes are available to vendors that support HIPAA ANSI 270/271 transactions. For the latest information on clearinghouse vendors and transactions they support, visit www.CIGNA.com/EDIvendors.  

The enhancement to provide more detailed copayment and coinsurance information for CIGNA's medical and dental plans* also applies to the CIGNA for Health Care Professionals website (www.cignaforhcp.com) for CIGNA networks and the Secured Provider Portal (www.gwhcignaforhcp.com) for GWH-CIGNA networks.

*Detailed eligibility and benefit information is not currently available on the CIGNA for Health Care Professionals website for CIGNA Voluntary or Medicare Advantage HMO plans.  To learn more about CAQH and the CORE initiative, go to www.caqh.org. 

Featured Article

• Cultural Competency - Increase Quality of Care and Improve Patient Compliance

Policy Updates

• Clinical, Reimbursement and Administrative Policy Updates
• Evaluation and Management Coding Review
• Preventive Care Coverage Update

Electronic Tools

• New eCourse Available
• Receive Your CIGNA Remittance Reports Online
• Transparent Cost of Care

Pharmacy Updates

• CIGNA Pharmacy Step Therapy Program to Expand
• New Value Prescription Drug List Option

Integration Updates

• Network Differences
• Ancillary Vendor and Facility Referrals
• Claim and Service Channels
• Brand Changes
• Revised GWH-CIGNA ID Cards
• Updates to the Secured Provider Portal
• Secure Websites

General Updates

• Eligibility and Benefit Enhancements
• New CIGNA Paper Claim and Correspondence Addresses and Fax Numbers
• Urgent Care for Non-emergencies

Helpful Reminders

• Reference Guides Updated
• Tell Us What’s Changed
• Use the Network
• Tools for Improving Claim Processing
• Access the Archives
• Go Green - Go Electronic