HIPAA 5010 Guides Compliance At Cigna (Frequently Asked Questions – Continued)
HIPAA 5010 Guides represented today in the blog refer to the transactions that are currently accepted and sent at Cigna in support of HIPAA 5010 compliance. Cigna is committed to helping physicians and hospitals successfully use HIPAA 5010 transactions releasing its HIPAA 5010 Guides FAQs.
HIPAA 5010 Guides FAQs
- What compliance level does Cigna validate on incoming transactions?
Cigna currently validates compliance Levels 1 through 4:
- Level 1 – Valid segments, segment order, element attributes, verifying that numeric data elements have a numeric value, validation of X12 syntax and compliance with X12 rules
- Level 2 – HIPAA implementation guide specific requirements like repeat counts, used vs. unused codes, elements and segments, and required or intra-segment situational data elements
- Level 3 – Balancing: balanced field totals, record or segment counts, financial balancing of claims and balancing of summary fields
- Level 4 – Specific inter-segment situations described in the HIPAA implementation guides (i.e. if A occurs then B must be present).
- What compliance level does Cigna validate on outgoing transactions?
Transactions sent from Cigna’s gateway are first validated for compliance Levels 1 through 4:
- Level 1 – Valid segments, segment order, element attributes, verifying that numeric data elements have a numeric value, validation of X12 syntax and compliance with X12 rules
- Level 2 – HIPAA implementation guide specific requirements like repeat counts, used vs. unused codes, elements and segments, and required or intra-segment situational data elements
- Level 3 – Balancing: balanced field totals, record or segment counts, financial balancing of claims and balancing of summary fields
- Level 4 – Specific inter-segment situations described in the HIPAA implementation guides (i.e. if A occurs then B must be present).
Cigna runs reports for Level 5 compliance to identify future improvement opportunities.
Level 5 – Code set testing: valid implementation guide specific code set values; accepted code set values are international classification of diseases, ninth edition, clinical modification (ICD–9CM), volumes one through three, health care financing administration common procedure coding system (HCPCS) except for level three or local codes and current procedural terminology, fourth edition (CPT-4).
- What’s been the response to industry-wide challenges with meeting migration deadlines?
Recognizing the challenges facing the industry, CMS issued updated guidance announcing an additional 90-day discretionary enforcement period for penalties – an extension that was welcomed by the entire industry.
- Will any standard transactions remain on version 4010?
No standard transactions will remain on version 4010 after all trading partners have migrated. However, other formats may exist for employers and other entities not subject to the regulation, who submit enrollment and payroll deduction information, similar to the information contained in the 834 and 820 transactions.
Learn more about 5010 complience at professional HIPAA Trainings