Questions & Answers About HIPAA Transaction And Code Sets Standards
- 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.
- How does HIPAA affect fee schedules?
To support HIPAA compliance, Cigna HealthCare will add the HIPAA-compliant codes to the 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)?
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:
- 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.
Eligibility and Benefits:
- 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).
- 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
- With what vendors is Cigna HealthCare connected?
Click here for vendors connected with Cigna HealthCare.