CommercialAdministrativeMedium impact
Eligibility verification enhancement for patients with plans administered by a third party
Cigna·Coverage
Effective date
Oct 1, 2023
We identified it
Jun 19, 2026
Summary
Cigna Healthcare now allows electronic eligibility verification (EDI 270/271 transactions) for patients with plans administered by third-party administrators (TPAs). Providers can identify these patients by looking for 'Shared Administration' or 'S' on their ID cards and must contact the TPA directly for eligibility, benefits, precertification, and claims questions.
Action Required
Immediately: Update eligibility verification workflows to recognize TPA-administered plans by checking for 'Shared Administration' or 'S' on Cigna ID cards. Train front desk staff to use EDI 270/271 transactions for these patients and contact the TPA (not Cigna) for eligibility, benefits, precertification, and claims inquiries. Update staff procedures to avoid calling Cigna Healthcare for TPA plan questions.