All PlansAdministrativeMedium impact
Post-payment claim reviews: Third-party vendor update
Cigna·Claims & Billing
Effective date
May 12, 2026
We identified it
May 13, 2026
Summary
Cigna Healthcare is updating their post-payment claim review vendors for 2026. Three vendors (Optum, Claritev, and CERIS) will conduct reviews of hospital bills, DRG claims, specialty pharmaceuticals, and medical implant devices. Providers may receive requests for medical records from these vendors but only one vendor per claim to avoid duplicates.
Action Required
Immediately: Billing team and medical records staff must be prepared to respond to post-payment review requests from three new vendors (Optum, Claritev, and CERIS). Train staff to recognize vendor outreach indicating they represent Cigna Healthcare. Establish workflow to provide medical records and documentation when requested, using contact information provided in vendor notifications. Prioritize timely responses to ensure efficient claim review process.