HIPAA 834, 5010 Platform (based on Cigna Standard Companion Guide created on 8/4/1997)
Cigna Platforms : Cigna has 2 platforms, Cigna Standard and Cigna Select
**Please consult with your carrier contact to confirm which of the two platforms should be used prior to configuring your client file
- Cigna Standard Platform (Companion Guide is excel document)
- Cigna Select Platform (Companion guide is word document, EN documentation here)
Carrier will send a trading partner agreement that provides the values to be populated in the following Header segments; ISA05, ISA06, ISA07, ISA08, and GS03.
CIGNA STANDARD: Client Level Configuration
- ISA06 /GS02= Interchange Sender ID- Client Tax ID #
- GS06: Unique numerical value that you select can be 1-9 digits long (Footer value GE02 should mirror what is populated in GS06)
- Ref38: Master Policy Number - Optional field for client that Cigna will ignore
- N102: Plan Sponsor Name - Company name
- N104: Plan Sponsor Tax ID - Client Tax ID #
Loop 1000C - Optional loop Cigna does not require
- N102: TPA or Broker Name
- N104: TPA or Broker Tax ID
The following fields are situational. Cigna will indicate if they are required to come across in the 2000 loop.
- Ref_OF: Subscriber Number (SSN of Subscriber) - No client level configurations are needed for this field
- REF_1L: Group/Policy Number - (Please note, Cigna prefers this information be sent in loop 2300. Carrier will indicate if value should be sent in loop 2000)
- REF_DX: Subgroup ID provided in group structure
- REF_ZZ: Class ID provided in Group Structure
- HD04: Plan coverage description provided in group structure
- REF_1L: Group structure information Group#, Branch, and Benefit option (combine all values)
Below is an example of how the Cigna structure should be passed in the REF*1L segment. Each Field needs to be left-justified and space filled
Bytes 1-7 Account Number (must be 7 bytes)
Bytes 8-13 Branch Code (must be 6 bytes)
Bytes 14-18 Benefit Option Code (must be 5 bytes)
Bytes 19-23 Network Code (must be 5 bytes)
Ex #1: Account number (1234567), Branch code (ACT), and Benefit Option Code (OAP) would look like - REF*1L*1234567ACT OAP~
Ex #2: Account number (1234567), Branch code (ACTIVE), Benefit Option Code (OAP), and Network code (TN808) would look like - REF*1L*1234567ACTIVEOAP TN808~
- GE02: Unique value selected by sender can be 1-9 digits long (Must mirror the GS06 value populated in the header)
Additional Carrier Notes
- Carrier platform is set to stop sending terminated records 14 days after the termination date and or termed on date has passed
- EN has added Cigna's PGP to the carrier template.
- PGP encryption is used but not always required. When not required to use PGP encryption, the carrier still uses a secure transmission protocol (SFTP)
- Please note that Cigna has several options of secure transmission. EN recommends selecting FTP with PGP or SFTP with or without PGP.
- If choosing SFTP without PGP encryption, you will need to select the "Skip Encryption" option on File Settings>Transmitting in the EDI engine.
- The Cigna spec includes instructions on including FSA products on the 834 file but EN does not support this.
- Open Enrollment
- Cigna expects the open enrollment file to include ended enrollments with a end of the plan year term date and new enrollments for the renewing plan year.
- All updates for the existing plan year plan to include, adds, terms, and changes, must be sent to the clients Cigna account contact to be manually updated after the open enrollment file is sent. Regular eligibility maintenance files should resume at the beginning of the new plan year.
- Cigna does NOT require an alternate naming convention for the open enrollment file
- Notify the clients Eligibility Analyst when the open enrollment file has been sent.