Home Providers Coverage and Claims HIPAA Compliance and Transaction Standards

HIPAA Compliance and Transaction Standards

How Cigna Healthcare and participating providers meet HIPAA compliance requirements.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a multi-part regulation that is having a wide-ranging effect on the way health care is administered and communicated. Cigna HealthcareSM complies with HIPAA and is committed to helping providers integrate HIPAA regulations into their business practices.

HIPAA regulations are designed to help protect patients' medical records and other health information and simplify health care administration.

What is HIPAA?

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is legislation enacted by the federal government to:

  • Ensure health insurance portability
  • Reduce health care fraud and abuse
  • Protect the privacy and confidentiality of health information
  • Simplify the administration of health care systems

Who Must Comply with HIPAA?

Health plans, health care clearinghouses and health care providers who engage in electronic transactions must comply. These are known as "covered entities." To a lesser degree, employers and business associates of covered entities are also affected.

How is Cigna Healthcare Meeting Compliance Goals?

We have made a significant investment in complying with HIPAA and plan to continue this investment. We have a dedicated team in place working to ensure the company complies with HIPAA regulations. The team includes project managers, legal counsel, information management and technology personnel and representatives from our business operations. The team has established a detailed work plan that includes an end-to-end analysis of our organization, as well as implementation of projects necessary to support compliance with these regulations.

What Should Providers Do to Remain HIPAA Compliant?

Cigna Healthcare is recommending the following steps for providers:

  • Consult with trusted legal counsel that is familiar with the HIPAA Privacy Rule and the Transaction and Code Sets regulations.
  • Contact your Clearinghouse and obtain guidance on how to be HIPAA compliant.
  • Ask your Practice Management Software vendor for information on how their software is compliant with HIPAA.
  • Make sure your billing procedures implement compliant codes and medical code sets by the compliance date.
  • Speak with your Cigna Healthcare contracting unit if you have questions about your contract and the codes to use for your reimbursement fees/schedules.

Please note that this affects only providers utilizing electronic submission for claims, inquiries, referral certification and authorizations.1

For more information on HIPAA, visit the US Department of Health and Human Services.

More in Coverage and Claims

  • Prior Authorizations
  • Coverage Policies
  • Appeals and Disputes
  • Claims
  • Payments
  • Referrals
  • More on HIPAA Compliance

  • Transactions and Code Set Standards
  • 1 The HIPAA regulations fully apply to covered entities operating within Puerto Rico.

    This information is not legal advice or a legal opinion on any specific facts or circumstances. This page is for general information purposes only and you are urged to consult a lawyer concerning your own situation and any specific legal questions you may have.

    I want to...
  • Get an ID card
  • File a claim
  • View my claims and EOBs
  • Check coverage under my plan
  • See prescription drug list
  • Find an in-network doctor, dentist, or facility
  • Find a form
  • Find 1095-B tax form information
  • View the Cigna Healthcare Glossary
  • Contact Cigna Healthcare
  • Audiences
  • Individuals and Families
  • Medicare
  • Employers
  • Brokers
  • Providers
  • Secure Member Sites
  • myCigna member portal
  • Health Care Provider portal
  • Cigna for Employers
  • Client Resource Portal
  • Cigna for Brokers
  • The Cigna Group Information
  • About Cigna Healthcare
  • The Cigna Group
  • Careers
  • Newsroom
  • Investors
  • Suppliers
  • Third Party Administrators
  • International
  • Evernorth Health Services
  • Cigna Healthcare. All rights reserved.
  • Privacy
  • Legal
  • Product Disclosures
  • Company Names
  • Customer Rights
  • Accessibility
  • Report Fraud
  • Sitemap
  • Cookie Settings
  • Disclaimer

    Individual and family medical and dental insurance plans are insured by Cigna Health and Life Insurance Company (CHLIC), Cigna HealthCare of Arizona, Inc., Cigna HealthCare of Illinois, Inc., Cigna HealthCare of Georgia, Inc., Cigna HealthCare of North Carolina, Inc., Cigna HealthCare of South Carolina, Inc., and Cigna HealthCare of Texas, Inc. Group health insurance and health benefit plans are insured or administered by CHLIC, Connecticut General Life Insurance Company (CGLIC), or their affiliates (see a listing of the legal entities that insure or administer group HMO, dental HMO, and other products or services in your state). Accidental Injury, Critical Illness, and Hospital Care plans or insurance policies are distributed exclusively by or through operating subsidiaries of The Cigna Group Corporation, are administered by Cigna Health and Life Insurance Company, and are insured by either (i) Cigna Health and Life Insurance Company (Bloomfield, CT); (ii) Life Insurance Company of North America (“LINA”) (Philadelphia, PA); or (iii) New York Life Group Insurance Company of NY (“NYLGICNY”) (New York, NY), formerly known as Cigna Life Insurance Company of New York. The Cigna Healthcare name, logo, and other Cigna Healthcare marks are owned by The Cigna Group Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna Healthcare.

    All insurance policies and group benefit plans contain exclusions and limitations. For availability, costs and complete details of coverage, contact a licensed agent or Cigna Healthcare sales representative. This website is not intended for residents of New Mexico.

    Selecting these links will take you away from Cigna.com to another website, which may be a non-Cigna Healthcare website. Cigna Healthcare may not control the content or links of non-Cigna Healthcare websites. Details