Get Cigna Electronic Remittance Advice Enrollment

The Cigna Electronic Remittance Advice Enrollment form is essential for providers looking to receive 835 electronic remittance advice files from Cigna. This guide provides a comprehensive step-by-step approach to filling out the form online, ensuring that you provide all necessary information for successful enrollment.

Follow the steps to complete your enrollment form

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Fill in the Payer Information section by entering 'Cigna' as the payer name and '62308' as the payer ID.
3. In the Receiver Information section, select who will receive your ERA files: Provider, Clearinghouse, or Vendor. Provide the Receiver Name and Availity Customer ID, along with the Contact Name, Telephone Number with extension, and Email Address.
4. Complete the Provider Information section by entering the complete legal name, address, city, state, and postal code of the provider.
5. In the Provider Identifiers Information section, enter the Federal Tax Identification Number (TIN) or Employer Identification Number (EIN) and the National Provider Identifier (NPI). Specify the Provider Type.
6. Provide the Provider Contact Information, including the contact person's name, telephone number, email address, and fax number.
7. Fill in the Electronic Remittance Advice Information by entering the TIN, preference for aggregation of remittance data, and NPI.
8. In the Submission Information section, choose the Reason for Submission: New Enrollment, Change Enrollment, or Cancel Enrollment. Enter the Authorized Signature and Printed Name of the person submitting the enrollment.
9. Enter the Requested ERA Effective Date to specify when you want the ERA to begin.
10. Once all sections are completed, use the Send Form option to submit the completed enrollment to Availity via email, fax, or mail as per the provided instructions.

Complete your Cigna Electronic Remittance Advice Enrollment form online today to ensure timely receipt of your ERA files.