ELECTRONIC DATA INTERCHANGE (EDI)

Electronic claim submission

For medical and behavioral health care providers

ELECTRONIC DATA

INTERCHANGE (EDI)

Welcome

We want to help you make the most of

your time, and provide the tools you

need to help lower your administrative

costs.

When you submit claims electronically,

it’s faster, more accurate, and less

expensive than submitting claims by

paper.

This course will provide you with the

information you need to submit health

care provider and facility claims

electronically to Cigna.

OVERVIEW

What’s inside?

• Required information to

submit an electronic claim

• Submitting coordination of

benefit information

• Understanding corrected

claims

• How to get started

WHAT IS ELECTRONIC DATA INTERCHANGE (EDI)?

Research* has shown that health care providers

who use EDI transactions can save time and

money through:

• Improving claim accuracy, while decreasing the

chance of transcription errors or missing data

• Reducing paperwork, and eliminating printing

and mailing expenses

• Eliminating the need to submit claims to multiple

locations

• Utilizing one user ID and password to access

and interact with multiple health plans

Vendors Vendors Vendors

Health care

provider

* Source: Council for Affordable Quality Healthcare (CAQH) 2016 Efficiency Index

Patient information is transferred between health care

providers and payers in a standardized and secure way.

EDI is the electronic exchange of health care information between health

care providers and facilities, payers, and vendors.

EDI TRANSACTION TYPES AND PAYER IDS

You can submit various claim types

through your clearinghouse, practice

management system, or EDI vendor,

including:

• Professional

• Institutional

• Dental (including encounters and

predeterminations)

• Coordination of benefit (COB) –

secondary, tertiary, etc.

• Corrected

Electronic claim submission allows you to submit claims quickly, track claims received,

and save time on resubmissions.

Primary and secondary claims

You can submit both primary and COB

claims electronically to Cigna.

You don't have to submit Medicare Part A

and B coordination of benefits agreement

(COBA) claims to Cigna This is because

the Medicare explanation of benefit (EOB)

or electronic remittance advice (ERA) will

show that those claims are forwarded to

Cigna as the secondary payer. Please

note that the CMS Medicare Crossover

process does not forward claims to Cigna

that were 100% paid by Medicare or 100%

denied by Medicare.

Use Cigna payer ID 62308

for submitting medical, behavioral*

dental, and Arizona Medicare

Advantage HMO electronic claims.

* Including employee assistance program.

HOW TO SUCCESSFULLY SUBMIT AN ELECTRONIC CLAIM

Patient’s ID number

Can be submitted with or without the suffix

(e.g., U12345678 or U1234567801)

Date of service, or admission and discharge

dates

Patient’s date of birth Diagnosis codes

(e.g., ICD-10 and DRG)

Patient’s first and last name Standard code sets

(e.g. CPT-4, revenue codes,

HCPCS, NDC, and CDT) and description of procedure

Patient’s address Charge amount for each procedure

If the patient is not the subscriber:

Subscriber’s name, ID number, and

date of birth

Note that if the patient ID includes a suffix, the

patient is considered the subscriber for the

claim submission.

The street address of the billing provider

Note that when submitting the billing address:

• It must be a street address

• The ZIP code must be nine digits

• PO boxes can be submitted in the “Pay to Provider”

field only

Name, Taxpayer Identification Number

(TIN), and National Provider Identifier*

(NPI)

of the billing provider

Place of service

Name and NPI

for the:

• Rendering provider • Attending physician

• Referring physician

Prior authorization number

If the service required prior authorization

* If enrolled in electronic funds transfer (EFT) with a payment bulking preference of NPI, the submitted

billing provider NPI will be used to bulk or group your payments and remittance advices. To learn more,

access the EDI Electronic Payment and Remittance Advice eCourse by logging in to the Cigna for Health

Care Professionals website (CignaforHCP.com

) > Resources > eCourses.

Information needed

SUBMITTING COORDINATION OF BENEFITS CLAIMS

To submit COB claims electronically, you’ll need

to enter information from the primary payer

ERA or EOP into the electronic claim. Be sure to

include:

• Updated subscriber information to reference the

subscriber of the COB payer. Enter the subscriber

from the primary payer in the Other Subscriber

Information fields.

• Payer paid, total non-covered, and remaining patient

liability amounts from the primary payer at both the

claim and service line levels, if available.

• Claim adjustment reason codes (may require

converting the primary payer's EOP into the standard

coding used in an ERA).

• Adjudicated procedure codes (may be different

than the submitted procedure codes).

• Primary payer's claim adjudication date.

You can submit COB claims (secondary, tertiary, etc.) electronically, eliminating the need to

copy primary explanation of payments (EOPs).

You can submit COB claims electronically, eliminating the need to attach primary

explanation of payments (EOPs).

It’s easiest to submit COB claims

electronically if you receive ERAs, and

your practice management system or

accounts receivable system is able to

automatically populate information from

the ERAs* into the electronic COB

claims.

Cigna already receives COB claims

directly from Medicare. If the Medicare

ERA contains an MA18 remark code, the

claim has been automatically forwarded to

Cigna, and there is no need to send a

COB claim to us.

* To learn more about ERA, access the Electronic Payment and Remittance eCourse

by logging in to CignaforHCP.com > Resources > eCourses.

ADDITIONAL CLAIM SUBMISSION TIPS

• If we receive a claim that requires

supporting documentation, we will request

the documentation from you.

• If you check a claim’s status on

CignaforHCP.com, and see that supporting

documentation is required for a pended

claim, you may upload the requested

documents there.

• You can upload attachments for your

pended claims as a registered user of

CignaforHCP.com. Log in the website, and

perform a claim search to find your pended

claim.

• To send supporting documentation when

the claim is submitted, indicate in the PWK

(claim supplemental information) segment

of Loop 2300 of the electronic claim that the

documentation will be sent through another

channel.

Attachments

• The indicators on the electronic claim

include the delivery method (PWK02)

for sending the attachment (e.g., fax or

mail), as well as the description code

(PWK01) for the type of attachment

(e.g., physician report or operative

notes).

• You can also mail supporting

documentation to the Cigna address on

the back of the patient's ID card.

Information related to attachments, anesthesia, and NDCs should not be

placed in the NTE (claim note) segment of the electronic claim. We will not

recognize the information if it’s included in the NTE segment. If you have

trouble completing the information, your vendor can help.

ADDITIONAL CLAIM SUBMISSION TIPS (CONT.)

Anesthesia

• Claims should be reported with

minutes in the SV104 segment of

Loop 2400 on professional claims.

• The surgical code related to

anesthesiology services can be

included, and additional anesthesia

units can be reported for additional

complexity beyond normal obstetric

services.

Anesthesia and National Drug Codes

National Drug Codes (NDCs)

• Drugs provided as part of a service should

be reported in the LIN segment of Loop

2410 on institutional claims.

• Compound drugs should have a HCPCS

code tied to a NDC. The association

number must be included to link together

the compound drug ingredients.

CORRECTED CLAIMS MADE EASY

What is a corrected claim?

This is a claim that was originally submitted

with incorrect or missing information, and is

resubmitted with the correct or updated

information.

How to submit a corrected claim

You can submit a corrected clam

electronically by completing the claim

information, and updating the claim

frequency code* with:

7 = Replacement

(replacement of a prior claim)

8 = Void

(void or cancellation of a prior claim)

* The claim frequency code allows us to

recognize the electronic submission as

a corrected claim, instead of as a

duplicate claim submission.

CLAIM ACKNOWLEDGMENTS AND TIMELY SUBMISSION

• Your vendor does the initial data integrity

validation to improve claim accuracy. This is

to make certain all required fields are

complete, and that only active codes are being

submitted.

• When we receive the claim, we will complete

the data integrity validation, and confirm

the patient is a Cigna customer with active

coverage.

We will also validate that the submitted codes

are consistent with the age and gender of the

patient. A claim acceptance at this point can

serve as proof of timely filing.

It's best to submit claims as soon as

possible.

If you're unable to file a claim right away, we

will consider:

• Participating health care provider claims that

were submitted three months (90 days) after

the date of service, or

• Non-participating health care provider

or patient claims submitted six months (180

days) after the date of service

If services are provided on consecutive days,

such as for a hospital confinement, the limit will

be counted from the last date of service.

If a claim is not accepted,

the claim acknowledgment will indicate if the

patient does not have Cigna coverage, or if there

is a data error within the claim.

A primary benefit of submitting claims

electronically is the timely notification of

whether your claims have been accepted

or rejected.

HOW TO GET STARTED SUBMITTING CLAIMS ELECTRONICALLY

Submitting claims electronically can be

done with minimal cost and time.

All you need are a computer and Internet

access. Then, simply choose how you want to

connect with Cigna.

• You can use one user ID and password to

work with multiple payers, including Cigna.

• For the latest information on our EDI

vendors and the transactions they support,

visit How to Submit Claims to Cigna

EDI offers flexibility in working with vendors of your choice.

WORKING WITH VENDORS TO SUBMIT CLAIMS

1. Your vendor converts your claim

information into the ANSI X12 format.

2. Cigna then transmits claim status

information to your vendor in the ANSI

X12 format.

3. Your vendor reformats the information into

a readable format.

4. How the claim and claim acknowledgment

information are displayed can vary by

vendor.

How does this work?

* Preferred provider organization

** Open Access Plus

If you have questions:

• About claims submitted through

your EDI vendor, contact your

vendor directly.

• About Cigna claim processing, call:

○ Medical and behavioral PPO* and

OAP** claims – 1.800.88Cigna

(1.800.882.4462)

○ All other behavioral claims –

1.800.926.2273

○ Dental claims – 1.800.Cigna24

(1.800.244.6224)

Congratulations.

You’ve completed the

Electronic Data Interchange

(EDI) Electronic Claim

Submission eCourse.

Bookmark

CignaforHCP.com

Today.

Offered by: Connecticut General Life Insurance Company or Cigna Health and Life Insurance Company.

All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company,

Connecticut General Life Insurance Company, Cigna Behavioral Health, Inc., and HMO or service company subsidiaries of Cigna Health Corporation. The Cigna name, logo,

and other Cigna marks are owned by Cigna Intellectual Property, Inc.

All models are used for illustrative purposes only.