Questions & Answers About HIPAA Transaction And Code Sets Standards

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.

To support HIPAA compliance, Cigna HealthCare will add the HIPAA-compliant codes to the fee schedules.

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

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.

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).

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

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