Latest Validation: June 2015

BPR: Version 2.5

Worksheet Version: 041115a

Updated: March 2017

• Cigna is aware of “gaps” where data fields in the transaction are not populated but the associated information is available on the web site.  Action to be taken: Looking at the eligibility engine since it is not providing all the data at this time.  Completion date:  No ETA.
• Occasionally, multiple eligibility records may be created and the incorrect one is not deleted from the system.  The transaction may report information from the incorrect record rather than the correct record.  Action to be taken: This is an eligibility loading issue, unsure of how they are addressing this as this time  Completion date:  No ETA.
• Cigna does not report benefits in the transaction for services that have been “carved out”, e.g. pharmacy.  Action to be taken: Telephone number currently provided, no changes are being made. Completion date:  No ETA.

Validation: April 2016

BPR: Version 2.3

Updated: February 2018

These findings apply to all products related to Payer ID = 87726. They do not apply to Medicaid or Medicare Products.

Member Information:

When patient is the subscriber, an INS segment is not reported in the 271 to indicate relationship of “Self”. Action to be Taken TR3 for the 271 does not require the reporting of an INS segment for “self”. Completion Date: N/A

Plan (EB03=30) and Service Level (EB03 = Service Type) Information:

For Hospital (Service Type = 47), 47 is identified as an active benefit in the EB01=1, even though no benefit information is reported at the plan level (EB03=30) or the service level (EB03=47). Action to be Taken: See below. Completion Date: N/A

UHC does not consider this an issue and refers providers to page 21 of their Companion Guide,“In the generic response (EB03=30) when benefit co-pay/co-insurance/deductible information for 48 –Hospital-Inpatient and 50 – Hospital-Outpatient are included in the response, then 47 – Hospital will not include benefit co-pay/co-insurance/deductible information.”

Latest Validation: December 2016

BPR: Version 3.91

Worksheet Version: 071416a

High Impact Best Practices: 22 of 22 are met.

Medium Impact Best Practices: 10 of 10 are met.