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Claims submission process enhancements offer real-time support for reduced denials
Act
by Jun 30, 2026
Effective date
Jul 1, 2026
Identified
Sep 29, 2026
Summary
Effective July 1, 2026, Cigna Healthcare will implement real-time validation of primary diagnosis codes at EDI claim submission. Claims with unacceptable primary diagnoses (manifestations, external causes, sequelae, or 'code first' conditions per ICD-10-CM guidelines) will be rejected at submission with rejection codes A7 or 255, allowing immediate correction rather than post-adjudication denial. This is not a new policy, but a timing shift of an existing edit to reduce downstream denials and rework.
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What to do
by Jun 30, 2026 · 4 steps
01Billing team must review and test claims workflows to ensure practice management system and/or clearinghouse can recognize and process 277CA rejection responses with codes A7 and 255.
02Billing and administrative staff must be trained to identify unacceptable primary diagnosis codes per Cigna Reimbursement Policy R38 (available at CignaforHCP.com > Resources > Clinical Reimbursement Policies) and correct them BEFORE claim submission.
03Update internal quality assurance processes to audit primary diagnosis code selection prior to submission.
04Contact your clearinghouse to confirm they have been notified and can support the new rejection handling.
If missed: Failure to implement these changes will result in increased claim rejections at submission requiring rework and resubmission, delaying revenue cycle.
Original notice
Claims submission process enhancements offer real-time support for reduced denials
providernewsroom.com · Always check the source before changing claims.