Clean Claim Requirements

Clean Claim Requirements (Cigna vendors) Clean Claim Requirements were developed with the goal to process all claims at initial submission. Before Cigna can process a claim, it must be a “clean” or complete claim submission, which includes the following information, when applicable: primary carrier explanation of benefits (EOB) when Cigna is the secondary payer prescription for physical Read More →

EDI Claims

Cigna Electronic Data Interchange Claims Process Cigna Electronic Data Interchange vendors securely transmit data electronically to Cigna and gain many benefits of this process. Filing paper claims can be time consuming. When you submit claims to Cigna electronically, including coordination of benefits (COB) claims, your practice can gain many benefits such as: Quicker claims submission, including Dental Health Read More →

7030

On September 4th, 2019 X12.org updated their home page with the latest 7030 Update. The X12N work group is responsible for 007030 TR3s (Technical-Report-Type 3) also known as HIPAA Implementation Guides. A public review period for each health care EDI Transaction must be conducted before these guides can become official. Below is the latest information Read More →

Provider Claim Guidelines

Operating Rules CAQH CORE 270: Connectivity Rule Guidelines Operating Rules CAQH CORE 270: Connectivity Rule requirements must be implemented by all entities seeking CORE Certification, including all other the CAQH CORE Eligibility and Claim Status Operating Rules. Operating Rules CAQH CORE 270: Connectivity Rule  state that the CAQH CORE 270 Rule is applicable only to the public Internet, which is a TCP/IP Read More →

CAQH CORE 270

CAQH CORE 270: Connectivity Rule Authentication Standards CAQH CORE 270: Connectivity Rule (Connectivity & Security Subgroup) evaluated the connectivity implementations used by its members, including what types of submitter authentication methods were being used. The results showed widespread use of both username/password and X.509 client certificate authentication. Though username/password is the base requirement with Phase Read More →

CAQH CORE Connectivity Safe Harbor

CAQH CORE Connectivity Safe Harbor Guidelines CAQH CORE Connectivity Safe Harbor requirements that a health plan must use if requested by a provider are described in CAQH CORE 270 Rule, Section 5, CORE Safe Harbor. The CAQH CORE Connectivity Safe Harbor specifies connectivity methods that application vendors, providers, and health plans can be assured will be supported Read More →

CAQH CORE 270: Connectivity Rule

CAQH CORE 270: Connectivity Rule: Relationship Between Phase I and Phase II CAQH CORE 270: Connectivity Rule is not a reference to X12 270 eligibility transaction. The CAQH CORE 270: Connectivity Rule Version 2.2.0, is payload agnostic, and is designed to carry any X12 v4010 and v5010 administrative transaction payload as well as any other non-X12 payload. The CAQH CORE Read More →