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Beginning October 31, 2023, when you verify eligibility for patients with a third-party administrator (TPA) plan, the electronic data interchange (EDI) 271 transaction will indicate whether they are covered or not covered using information from Cigna Healthcare, as well as the TPA. It will also provide the TPA name and telephone number to confirm further eligibility or benefit information.
What this means for you
This enhancement will provide more clarity in the coding used by clearinghouses and electronic medical records vendors to electronically confirm eligibility for your patients and provide information on the entity to contact for benefit details. You may still need to call the TPA for further information.
What are TPA plans?
Employer groups who require a high level of customization and flexibility may choose to have TPAs administer their benefit plans. Cigna Payer Solutions has relationships with select TPAs to help meet the needs of employer groups by providing a wide range of complementary product solutions, including access to our medical network of providers.
How do I determine if my patient has a TPA plan?
You have two options to determine if your patient has a TPA plan: View their ID card or log in to the Cigna for Health Care Professionals website (CignaforHCP.com) to review their coverage details.
Patients with a TPA plan will have “Shared Administration” (or the letter “S”) at the bottom right of their TPA ID card (see the sample below). This designates that Cigna Healthcare shares the administration of the plan with a TPA. The ID card also includes the TPA phone number to call for eligibility and benefits information (see the sample below).
 
See above for "Shared Administration" identifier. See above for eligibility/verification phone number.
Thank you for the care you provide to our customers.
Provider Digital Solutions & Engagement Cigna Healthcare
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