Electronic Tools

November 2011

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HIPAA 5010 updates

In January 2009, the U.S. Department of Health and Human Services (HHS) published final rules adopting X12 Version 5010 for HIPAA electronic health care transactions. Use of version 5010 by HIPAA covered entities is required by January 1, 2012.

 

In addition to our efforts to comply with the HIPAA 5010 electronic transaction standards, Cigna has also made enhancements to these electronic transactions to help you complete administrative tasks more efficiently. These updates will be implemented in support of the migration from 4010 to 5010. Here are examples of the changes you will see:

  • The “Billing Provider Address” must be a street address. A PO or lock box address should only be submitted in the “Pay to Provider” address field.
  • Subscribers will be uniquely identified by their ID number across all HIPAA EDI transactions.
  • The “Provider Accepts Assignment” indicator will be required on all claims.
  • We will provide remittance advice remark codes (RARC) in addition to the claim adjustment reason codes (CARC) on the 835. This will give you a more detailed explanation of the difference between the billed amount and paid amount.
  • We will add hospital and mental health coverage information to the 271 eligibility and benefit response, as well as detailed urgent care benefits.
  • A 277 claim acknowledgment will be sent for every claim received through the Cigna gateway.

Please confirm that your system and vendor are set up to receive transactions from Cigna and that the appropriate format, usage, and code list updates have been made to avoid transaction rejections and claim processing delays.

Testing

Cigna is testing these electronic transaction enhancements in two phases:

Phase 1 | 3rd and 4th quarter - 2011
Phase 2 | 4th quarter - 2011
  • 837I Claim submission (institutional)
  • 837P – Claim submission (professional)
  • 837D – Claim submission (dental)
  • 835 – Payment and remittance advice
  • 277 – CA (claim acknowledgment)
  • 270/271 Interactive
  • 276/277 Interactive
  • 278 Request/response interactive

Please work with your trading partners to identify their testing dates, and to confirm when they will be ready to accept 5010 transactions.

When will I see these changes?

You will experience these changes as your vendor begins to exchange 5010 transactions with Cigna. Some clearinghouses or vendors may begin automatically converting transactions between the current version (4010) and the new version (5010). As a result, you may notice these changes earlier or later than the date your system creates transactions in version 5010.

Check with your vendor or software supplier about their 5010 readiness and testing plan. Cigna will no longer accept 4010 transactions after a trading partner has migrated to 5010.

 

Table of Contents

Feature Article:

Policy Updates:

 

Integration News:

Electronic Tools:

Pharmacy News:

General News:

 

Helpful Reminders:

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