CommercialAdministrativeMedium impact
Urgent care billing guidelines for HMO providers
Cigna·Claims & Billing
Effective date
Oct 2, 2024
We identified it
Jun 19, 2026
Summary
Cigna Healthcare updated urgent care billing guidelines for HMO providers, requiring the use of POS-20 code for urgent care facility services and specific documentation when services are rendered by non-participating or out-of-area providers. Providers must still ensure urgent care is arranged within required timeframes regardless of financial responsibility.
Action Required
Immediately: Billing team must update claim submission procedures to include POS-20 code for all services rendered in urgent care facilities. Add standard note 'Seen by another provider in the office due to urgent care/physician on call covered for assigned PCP' when applicable for out-of-network urgent care claims believed to be Cigna Healthcare's financial responsibility.