Questions and Answers About HIPAA Regulation Implementation

How Cigna HealthCare is implementing the HIPAA regulations
Does Cigna HealthCare have a contingency plan for handling non-compliant claims and other transactions after October 16, 2003?

Cigna HealthCare does not anticipate rejecting claims due to non-compliant codes after the HIPAA Transaction & Code Set Standards become effective. In fact, we will be monitoring our clearinghouses to ensure that our claim processing turnaround continues to meet federal and state guidelines.

Our contingency plan for handling claims and other transactions from providers and/or clearinghouses that are not HIPAA-compliant as of 10/16/03 is to continue to accept and send transactions in current formats while our providers and/or clearinghouses work toward compliance.

Because we do not anticipate an adverse impact to our claim processing turnaround time, we want to assure our providers that advance payments are not necessary.

How will Cigna HealthCare log all disclosures of protected health information (PHI) as required by the Accounting of Disclosures Section?

We have developed a tracking system that will enable us to track disclosures and to provide this information upon request to members.

Providers may also need to be prepared to share an accounting of disclosures they have made outside of treatment, payment or health care operations.

When will Cigna HealthCare be ready to conduct testing?

We are closely monitoring the implementation efforts of our primary EDI clearinghouses, which include Electronic Network Services (ENS), InMediata, MediFax, ProxyMed, WebMD and SSI Group. Each clearinghouse has agreed to support a mixture of the transactions with us. We began testing with these clearinghouses in 2003 and the work remains in progress.

At this time we do not plan to conduct tests with individual providers, hospitals and other ancillary providers. Please contact your clearinghouse for testing information and instructions or a copy of their Companion Guide to support Cigna HealthCare EDI transactions as well as for implementation schedules and information.

Will Cigna HealthCare be providing billing software/implementation or companion guides?

No. Since we are conducting testing with clearinghouses, we will not provide these types of materials. Please contact your clearinghouse for testing information and instructions or a copy of their Companion Guide to support Cigna HealthCare EDI transactions as well as for implementation schedules and information.

What contingency plans has Cigna HealthCare put in place, in case you are not ready?

Cigna HealthCare is committed to being compliant; however contingency plans and discussions regarding alternatives are being developed.

If Cigna HealthCare is sending me a data feed because I'm a delegated provider or receiving data for capitation, should I expect any changes?

Privacy: We are in the process of contacting our delegated providers to review the electronic feed they receive, to determine whether changes are required and will develop a supporting testing schedule.
Transaction & Code Sets: There are no changes required.