Starting June 19, providers can now receive National Provider Identifier (NPI)-specific tiered benefit information through the 270/271 eligibility and benefit inquiry and response transaction set. This phase 2 enhancement applies to medical, dental, and behavioral health providers.

How this helps your office

Building on phase 1 (live in April), this enhancement can help your office get even more targeted eligibility and benefit details in the 271 response – so you can confirm coverage and patient cost-share with fewer follow-ups. These updates also support CAQH^® CORE¹ compliance requirements.²

Enhancement details

When a patient has tiered benefits, the 271 response will now return only the benefit information applicable to the submitting provider’s network tier based on the NPI submitted on the 270 request – helping reduce back-and-forth when your office is verifying benefits for your specific participation level.

What this means for your EDI vendor

• This enhancement has been tested and aligns with CAQH CORE requirements.
• An updated 270/271 companion guide is available and has been shared with electronic data interchange (EDI) vendors.
• Your vendor may contact you regarding implementation or testing.
• No action is needed from your office unless your EDI vendor instructs you to update your system or complete testing.

Questions?

If you have questions about how this change may affect your eligibility and benefit checks (270/271), please contact your EDI vendor first. They can confirm whether any system updates or testing is needed and provide guidance that aligns with your workflow.

1    Council for Affordable Quality Healthcare^® Committee on Operating Rules for Information Exchange.

2    Cigna Healthcare is a CAQH CORE-certified entity, demonstrating compliance with the administrative simplification provisions of the Affordable Care Act.