Billing can be complex, even with strong processes in place. To support accurate reimbursement in accordance with your agreement and applicable billing requirements – and help ensure cost-effective care for your patients – we conduct post-payment reviews on select claims, consistent with industry standards.

We value your partnership and the care you provide to our customers. As part of our ongoing efforts to make the review process more coordinated, consistent, and streamlined – with clear requests and controls designed to prevent duplicate outreach – we’re sharing an update on the vendors who may contact your office.

Post-payment claim review vendors
Cigna Healthcare^® partners with specialized vendors that conduct post-payment claim reviews. In 2026, we’re partnering with the vendors noted below to enhance consistency, reduce administrative friction, and improve coordination. The following vendors may contact you on behalf of Cigna Healthcare in connection with a post-payment claim review:

• Optum – began conducting reviews in 2025 and will continue in 2026.
• Claritev – began conducting reviews in April 2026.
• CERIS – expected to begin reviews in summer 2026.

What to expect

You may receive a request for medical records and/or be contacted by one of these vendors on our behalf.

We recognize these requests require time and coordination. To help minimize disruption to your office:

• Only one vendor will be assigned to a specific claim, avoiding duplicate requests.
• Requests will include clear submission instructions and contact information.
• Vendor outreach will indicate it is on behalf of Cigna Healthcare.

We appreciate your timely attention to any requests you receive, which helps ensure claims are reviewed efficiently and accurately.

Types of reviews

Our vendors support several types of post-payment reviews, including:

• Hospital bill review:
  Onsite or desk review of medical records and bills to confirm alignment with clinical documentation and coding.
• Diagnosis-related group (DRG) review:
  Review of claims paid under DRG contracts to validate clinical and coding accuracy.
• High-cost specialty pharmaceutical review:
  Review of facility-administered pharmacy services against medical records.
• Medical implant device review:
  Review of claims involving implantable devices to confirm appropriate billing.

Questions?

If you have questions about a review, required documentation, or how to submit records, please use the contact information included in the vendor notification for direct support.