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Cigna Electronic Transaction Enhancements

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Cigna implemented changes in support of 5010 compliance during the last quarter of 2011. In addition to their efforts to comply with the HIPAA 5010 electronic transaction standards, Cigna also made enhancements to these electronic transactions:

  • Cigna consolidated to a single gateway, allowing vendors to route all Cigna claims to one Cigna payer ID (62308). Claims no longer need to be submitted to different Cigna payer IDs by product or line of business, including claims for patients in plans associated with the GWH-Cigna network.
  • The “Billing Provider Address” must be a street address. A PO or lock box address should only be submitted in the “Pay to Provider” address field.
  • Subscribers will be uniquely identified by their ID number across all HIPAA EDI transactions.
  • The “Provider Accepts Assignment” indicator is required on all claims.
  • Cigna now provides remittance advice remark codes (RARC) in addition to the claim adjustment reason codes (CARC) on the 835. This will give you a more detailed explanation of the difference between the billed amount and paid amount.
  • Hospital (service type 47), urgent care (service type UC), and mental health (service type MH) coverage information has been added to the 271 eligibility and benefit response, as well as detailed urgent care benefits.
  • A 277 claim acknowledgment will be sent for every claim received through the Cigna gateway.

Cigna advises that providers confirm that their system or vendor is set up to receive transactions from Cigna and has made the appropriate format, usage, and code list updates to avoid transaction rejections and claim processing delays. 

Paper claims that are sent to Cigna's mail room are scanned and become electronic claims.  Because of this, the "Billing Provider Address" must be submitted as a street address.