December 16, 2025
November 2025
In case you missed them, here is a recap of and links to all of the U.S. commercial articles that were published in the Provider Newsroom in November.
(November 18, 2025) CMS, Office of the Inspector General, and other national payers have identified an increasing pattern of E/M services being billed at a higher level than was performed. To promote accurate and consistent reimbursement, and to protect customers from potential overbilling, we implemented a new E/M Accuracy (R49) medical reimbursement policy on October 1, 2025.
Professional claims for evaluation and management services
(November 18, 2025) Cigna Healthcare implemented a new reimbursement policy, Evaluation and Management Coding Accuracy (R49), to review professional claims billed with CPT E/M codes 99204-99205, 99214-99215, and 99244-99245. The policy is effective for dates of service on or after October 1, 2025.
Offset process for overpayment recovery training available
(November 14, 2025) Did you recently receive a letter from Cigna Healthcare about the expansion of offsetting for certain overpaid claims? We are pleased to announce that we will be offering informative training sessions starting in November to help clarify this process and address any questions you may have.
(November 13, 2025) The Provider Newsroom features news and updates on topics relevant to you ‒ all in one place. Learn tips to navigate the Provider Newsroom for easy access to information on multiple lines of business, as well as a new feature that allows you to personalize your newsfeed to the topics that are most important to you.
Your news, your way: An enhanced experience in the Provider Newsroom
(November 13, 2025) The Provider Newsroom has new features! Highlights include the ability to create an account to select the topics of most interest to you, easier navigation, and design enhancements for a cleaner and more streamlined experience.
Change in prior authorization administration for DME services, effective March 1, 2026
(November 13, 2025) On January 1, 2026, Cigna Healthcare Medicare Advantage becomes HealthSpring. Effective March 1, 2026, HealthSpring will manage prior authorizations for durable medical equipment (DME) services, as well as orthotic and prosthetic codes. EviCore by Evernorth will continue to manage prior authorizations for DME services through February 28, 2026.
Latest news for Cigna Healthcare providers
(November 10, 2025) Wondering what’s been added since your last visit to the Provider Newsroom? Access a summary of the latest news by month.
Latest news for Evernorth Behavioral Health providers
(November 10, 2025) Wondering what’s been added since your last visit to the Provider Newsroom? Access a summary of the latest news by month.
(November 7, 2025) Each year, we evaluate our Behavioral Complex Case Management Program to ensure we’re delivering meaningful support and meeting accreditation standards. We are pleased to share key insights from the Evernorth Behavioral Health evaluation for 2024, reflecting our continuous commitment to improving outcomes for your patients.
The Cigna Group Appoints Dr. Amy Flaster Chief Medical Officer
(November 6, 2025) Dr. Flaster, who joined the company last year as Chief Medical Officer of Cigna Healthcare, will now serve in an expanded enterprise role across both Cigna Healthcare and Evernorth. In this capacity, she will spearhead efforts to advance clinical excellence, introduce innovative care models, strengthen and grow clinical teams, and leverage technology to enhance whole-person health.
Immunization Fee Schedule (NIIFS) quarterly update
(November 4, 2025) The Cigna Healthcare National Injectable and Immunization Fee Schedule (NIIFS) is used to reimburse professional and facility providers for payment of injectable drugs and immunizations. The 2025 fourth quarter NIIFS has been updated and will become effective on November 1, 2025.
Providers contracted for commercial and IFP plans should continue using CignaforHCP.com
(November 4, 2025) Earlier this year, Cigna Healthcare Medicare Advantage introduced Availity Essentials as its new provider portal. However, those contracted with Cigna Healthcare commercial and Individual & Family Plans should continue using the Cigna for Health Care Professionals website to complete tasks like verifying eligibility and benefits, viewing customer ID cards, and checking the status of claims.
New online claim attachment features now available on CignaforHCP.com
(November 3, 2025) Beginning November 3, enhancements to the online claim process on the Cigna for Healthcare Professionals portal (CignaforHCP.com) will improve usability, accuracy, and the overall provider experience. Enhancements include improved reliability for pended claim attachments and expanded claim attachment status details.
New online claim attachment features now available on Provider.Evernorth.com
(November 3, 2025) Beginning November 3, enhancements to the online claim process on the Evernorth provider portal (Provider.Evernorth.com) will improve usability, accuracy, and the overall provider experience. Enhancements include improved reliability for pended claim attachments and expanded claim attachment status details.
(November 1, 2025) With the arrival of cold and flu season, your office will likely see a rise in patients with respiratory infections, which may vary from the common cold to respiratory syncytial virus. Patients often anticipate receiving an antibiotic; however, these typically viral illnesses cannot be effectively treated with antibiotics. HEDIS includes various measures that focus on the appropriate prescribing of them.
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