CIGNA HealthCare Processes and Procedures To Ensure HIPAA Privacy Compliance

Effective 4/7/03

Telephonic Inquiry

Validation questions on our Interactive Voice Response (IVR) capability ensures that callers requesting access to protected health information (PHI) are valid recipients. Responses to these questions are matched against claim systems for providers. In addition, filters within the capability limit provider access to "minimum necessary" claim information.

Providers are required to enter the following information for both telephonic and self-service inquiries about a CIGNA HealthCare member's claim or eligibility/benefits:

All Inquiries - Telephone

Caller inputs the following information via the telephone keypad:

• Subscriber ID #
• Member Date of Birth (MMDDYYYY)
• Provider Tax ID
• Date of Service (required for claim status inquiries only)

The information provided is verified against our systems

• If information doesn't match, the caller is transferred to a Customer Service Associate (CSA) for assistance.
• The CSA will ask further verification questions to validate the caller. These will include information specific to the inquiry. If CSA is able to validate information on file, the caller will receive the same information they do today.

Faxback Requests on Multiple Member Inquiries

Our IVR self-service has the option for you to receive claim status or eligibility and benefits information on multiple members via fax. HIPAA regulations require that all faxes be sent to a provider that has physical control of or safeguards around their fax machine. If you request to receive information via fax, you will hear a disclaimer message advising that entry and confirmation of your fax number, as part of the call, constitutes your representation of such controls or safeguards. A confirmation letter of your fax number entered will be sent to your office via U.S. Mail confirming that this is the fax number you want on file for receipt of future faxes.

CIGNA for Health Care Professionals Website Verification

Providers may inquire online about a CIGNA HealthCare member's claim, or eligibility / benefits.

Patient Eligibility/Benefits

There are three different search methods for Patient eligibility / benefits. Enter the following information:

1. Patient ID and Patient DOB
2. Subscriber Last Name, Patient First Name and Patient DOB
3. Patient ID, Subscriber Last Name and Patient First Name

The subscriber's information will be displayed when searching for a dependent; all dependents will be displayed when searching for a dependent child.

Claim Search

There are four different search methods to search for a claim.

1. Patient ID Name/Search
2. Enter Patient ID and Patient DOB, or
3. Enter Subscriber Last Name, Patient First Name and Patient DOB, or
4. Enter Patient ID, Subscriber Last Name and Patient First Name
5. Provider Assigned Account # Search
6. Claim / Reference # Search
7. Provider TIN Search and Date of Service

The results screen on the TIN Search will display all members whose claims were submitted claims under the specific TIN. On all other searches, the results screen will show information only about the specific member whose data you entered.

Secure Email

CIGNA HealthCare has a secure email process for sending and receiving email messages containing sensitive information, including PHI.

Email messages from CIGNA HealthCare containing PHI or other confidential or highly sensitive information will be sent via secure email. Your regular email program will receive an email message containing an Internet link that you will click to retrieve the message in your CIGNA secure mailbox. You will then log in to your secure mailbox and retrieve the secure message. Each external designee will have his/her own secure mailbox ID and password.

• The first time you receive a secure email from CIGNA HealthCare, you will be asked to set up a secure mailbox ID and password.
• Secure emails you receive will include an Internet link that you can click on to retrieve the message from your CIGNA secure mailbox, using your ID and password.
• Once you have logged on to the secure mailbox, you can reply, download attachments, and attach files to send back to the CIGNA HealthCare address that initiated the message.
• Messages from you will be protected by this secure email solution only when you reply to a message initiated by CIGNA HealthCare.
• Your CIGNA HealthCare representative will send you an instruction sheet when applicable.

Should you need assistance while registering, please contact the CIGNA HealthCare Customer Support Center at 800.284.8346.

If your organization has developed its own encryption / email solution, please let your provider representative know what system you are using. CIGNA HealthCare is willing to work with most secure messaging tools.