HIPAA Compliance and Transaction Standards

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a multi-part regulation that is having a wide-ranging effect on the way health care is administered and communicated. Cigna Healthcare^SM complies with HIPAA and is committed to helping providers integrate HIPAA regulations into their business practices.

HIPAA regulations are designed to help protect patients' medical records and other health information and simplify health care administration.

What is HIPAA?

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is legislation enacted by the federal government to:

• Ensure health insurance portability
• Reduce health care fraud and abuse
• Protect the privacy and confidentiality of health information
• Simplify the administration of health care systems

Who Must Comply with HIPAA?

Health plans, health care clearinghouses and health care providers who engage in electronic transactions must comply. These are known as "covered entities." To a lesser degree, employers and business associates of covered entities are also affected.

How is Cigna Healthcare Meeting Compliance Goals?

We have made a significant investment in complying with HIPAA and plan to continue this investment. We have a dedicated team in place working to ensure the company complies with HIPAA regulations. The team includes project managers, legal counsel, information management and technology personnel and representatives from our business operations. The team has established a detailed work plan that includes an end-to-end analysis of our organization, as well as implementation of projects necessary to support compliance with these regulations.

What Should Providers Do to Remain HIPAA Compliant?

Cigna Healthcare is recommending the following steps for providers:

• Consult with trusted legal counsel that is familiar with the HIPAA Privacy Rule and the Transaction and Code Sets regulations.
• Contact your Clearinghouse and obtain guidance on how to be HIPAA compliant.
• Ask your Practice Management Software vendor for information on how their software is compliant with HIPAA.
• Make sure your billing procedures implement compliant codes and medical code sets by the compliance date.
• Speak with your Cigna Healthcare contracting unit if you have questions about your contract and the codes to use for your reimbursement fees/schedules.

Please note that this affects only providers utilizing electronic submission for claims, inquiries, referral certification and authorizations.¹

For more information on HIPAA, visit the US Department of Health and Human Services.

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¹ The HIPAA regulations fully apply to covered entities operating within Puerto Rico.

This information is not legal advice or a legal opinion on any specific facts or circumstances. This page is for general information purposes only and you are urged to consult a lawyer concerning your own situation and any specific legal questions you may have.