• How does HIPAA affect provider reimbursement contracts?
• How does HIPAA affect fee schedules?
• How are your web-sites impacted by the transaction and code sets regulations?
• What changes did CIGNA HealthCare make to Provider Self-Service (PSS)?
• What is Provider Self-Service?
• With what vendors is CIGNA HealthCare connected?

1. How does HIPAA affect provider reimbursement contracts?

All electronic claim submissions must now contain HIPAA compliant medical and non-medical code sets. Therefore, contracts may need to be modified in order to reflect a valid alignment of contracted procedures and corresponding reimbursement rates.

2. How does HIPAA affect fee schedules?

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3. How are your web-sites impacted by the transaction and code sets regulations?

The HIPAA Transactions & Code Sets regulations do not affect myCIGNA.com, CIGNA.com and our CIBUR site.

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4. What changes did CIGNA HealthCare make to Provider Self-Service (PSS)?

In July 2003, PSS was changed to support eligibility and benefit inquiries and response (270/271), as well as claim status inquiries and response (276/277).

Here are some of the changes you'll notice:

Claim Status:

• The status field now shows whether the claim is pending or in process.
• Explanation of Payment — Remark codes, now called "Additional Information," are now HIPAA-compliant. These codes are used only for electronic transactions (PSS). On a single inquiry you are now able to inquire about services provided within a 180-day date range.

• Product Type
  The screen now shows additional information when applicable:
• Medical Group/Risk Group Name
• PCP phone number
• Outpatient hospital out-of-pocket expense
• MRI/Lab/X-ray copayments
• The coinsurance percentage CIGNA HealthCare applies to a covered expense (instead of the percentage the member must pay).

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5. What is Provider Self-Service?

With this "application," or tool, you can check your patient's benefits, eligibility or claim information conveniently and securely online. Access is available during the following hours:
Monday through Friday, 7 a.m. to Midnight ET
Saturday, 7 a.m. to 8 p.m. ET
Sunday*, 2 p.m. to 7 p.m. ET

6. With what vendors is CIGNA HealthCare connected?

Click here for vendors connected with CIGNA HealthCare.

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.