Special Information for Providers about HIPAA (Health Insurance Portability and Accountability Act)
The Health Insurance Portability and Accountability Act of 1996, more commonly known as HIPAA, is a multi-part regulation that is having a wide-ranging effect on the way health care is administered and communicated. Cigna HealthCare is committed to integrating the HIPAA regulations into its business practices to meet the Act's various deadlines.
The new HIPAA regulations provide national standards designed to meet the objectives Cigna HealthCare has had for years: protecting our members' confidential information and simplifying health care administration.
General Overview
Cigna HealthCare supports our members' right to privacy and have had measures in place for some time to protect confidentiality. We also support the HIPAA standardization initiatives and have worked for several years to promote the use of electronic transactions (EDI) through our clearinghouse partners. We are enhancing our processes, systems and overall practices and are testing HIPAA-compliant transactions with our trading partners and EDI clearinghouses.
Click here for further information about HIPAA and what you should be doing to become HIPAA-compliant.
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HIPAA Privacy Rule
The HIPAA Privacy Rule was developed to protect the confidentiality of individually identifiable health information and other personal information. Cigna HealthCare complies with the requirements of this rule that went into effect April 14, 2003.
Process Changes and Verification Procedures
To ensure Privacy Rule compliance, Cigna HealthCare modified and changed business functions. For providers, new processes were implemented for:
- Telephonic inquiry
- Faxback Requests on Multiple Member Inquiries
- Provider Self Service (PSS) Verification
- Secure email
Privacy Notice to Subscribers
As required by the law, Cigna HealthCare sent subscribers a Notice of Privacy Practices explaining how personal health information is used and disclosed and members' individual rights under the regulation. This Notice and the Individual Rights Request forms are available here.
Click here for more information about the Privacy Rule, Business Associate Agreements, and Individual Rights.
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Transactions and Code Sets
The Transactions and Code Set standards have far-reaching effects on our industry. This part of the HIPAA law requires providers and health plans to use standard content, formats and coding for a select set of common electronic transactions. The original effective date of this part of the regulations was set for October 2002, but was extended to October 16, 2003 for those covered entities that filed for an extension. Cigna HealthCare did file for the extension.
Providers who transmit information electronically must adopt standard medical codes, and eliminate the use of duplicative and local codes. Health plans, which use a wide variety of codes and formats to transact business with providers and clients, must be able to accept and respond to the standard electronic data interchange (EDI) transaction formats and related medical and non-medical code sets.
HIPAA-Compliant Transactions
HIPAA-Compliant Codes
- Information extracted from the Health Care Financing Administration Common Procedural Coding System.
HCFA Common Procedural Coding System
131 - ICD-9-CM Procedure
132 - NUBC Codes
134 - NDC
135 - American Dental Association
139 - Claim Adjustment Reason Codes
229 - DRG
235 - Claim Frequency Type Codes
240 - NDC by Format
245 - NAIC Code
307 - National Association of Boards of Pharmacy Number
411 - Remittance Remark Codes
513 - HIEC Product/Service Codes
530 - NCPDP Reject/Payment Codes
537 - HCFA National Provider Identifier
540 - HCFA National PlanID
Additional Information
Click here for a summary of additional information about Transactions & Codes Sets.
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Cigna HealthCare continues to implement the systems and business process changes necessary to receive and transmit the HIPAA standard transactions. Click here for specific details.
This document provides a general outline of HIPAA information and does not constitute legal advice or the full complement of actions you need to take to be compliant with the HIPAA regulations.
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