April 2026

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 April.

Early prevention: New implications for high blood pressure management

(April 30, 2026) Recent industry studies on the long-term effects of high blood pressure are revealing the importance of early prevention and intervention, particularly in young adults below age 40, before symptoms arise.  Several studies now support earlier screening and management to address the root causes of cardiovascular disease more proactively.

How women’s unique health needs impact mental health

(April 30, 2026) Each year, 1 in 5 women in the United States experiences a mental health issue. Mental health is a matter of mind and body — particularly for female patients, whose unique biological factors can impact both physical and mental health. Reproductive health and accompanying hormonal changes, women-specific health conditions, and unique lifestyle risk factors can affect a woman’s mental and emotional health.

RSV season may end, but newborn vulnerability does not

(April 29, 2026) When caring for expectant patients, your guidance on respiratory syncytial virus (RSV) prevention can make a meaningful difference ‒ helping protect newborns from serious illness during their earliest, most vulnerable months. RSV is the leading cause of infant hospitalization in the U.S., with risk being especially high in the first months of life.

Webinars For Health Care Providers

(April 28, 2026) May through July 2026, providers are invited to attend free interactive webinars to learn how to use the Cigna for Health Care Professionals website (CignaforHCP.com)  to check eligibility and benefits, determine if precertification is required, inquire about claim status and coding edits, submit claims for adjustment or appeal, and more. Pre-registration is required.

Simplifying and reducing prior authorization with industry peers

(April 24, 2026) Today, the Cigna Group joined leading health plans in a commitment to standardize electronic prior authorization submission requirements for commonly reviewed medical services. This effort is designed to streamline administrative workflows for providers and accelerate patients’ access to care. By the end of this year, this standardized approach is expected to apply to medical services representing more than 70% of Cigna Healthcare’s prior authorization volume.

Enhancements to the 270/271 eligibility and benefits transactions to give faster and clearer results

(April 24, 2026) Starting April 24, 2026, medical, dental, and behavioral health providers will see improvements to our 270/271 eligibility and benefits transactions. These updates are designed to help you verify coverage more easily and receive faster, more consistent eligibility and benefit information.

California HMO provider appointment access and availability

(April 22, 2026) Each year, in compliance with the State of California Department of Managed Health Care (DMHC), we require randomly selected Cigna Healthcare network-participating providers to complete the Provider Appointment Availability Survey (PAAS). This survey measures access to care for California HMO plan enrollees.

National Speech-Language-Hearing Month: Easy access to virtual care

(April 22, 2026) The need for speech therapy is growing — and access is often the hardest part. Virtual speech therapy offers a way to help bridge these gaps by connecting eligible patients with licensed speech‑language pathologists, with outcomes comparable to in-person therapy.

Update to our interactive voice response (IVR) phone system

(April 16, 2026) We are seeing an increase in unapproved bot calls that are reaching our Provider Service Call Center advocates without proper authentication through the interactive voice response (IVR) phone system. To help reduce wait times, ensure advocates are available for legitimate calls, and protect patient information, we are adding a new step to our IVR phone system.

Cigna Specialty Care Options programs: Changes to the drug list

(April 14, 2026) The Cigna Specialty Care Options and Cigna Specialty Care Options Plus programs identify customers whose nononcology and oncology specialty medications are being administered in a higher-intensity setting (e.g., outpatient hospital) to determine whether a less-intensive site of care is clinically appropriate. Cigna Healthcare recently expanded the Specialty Care Options and Specialty Care Options Plus drug list.

Specialty Medical Injectables with Reimbursement Restriction: List updates

(April 10, 2026) The Cigna Healthcare Specialty Medical Injectables with Reimbursement Restriction guidelines state that certain injectables must be dispensed and their claims must be submitted by a specialty pharmacy contracted by Cigna Healthcare, unless otherwise authorized by Cigna Healthcare. On March 30, 2026, the Specialty Medical Injectables with Reimbursement Restriction drug list was expanded.

Adoption of LOCUS and CALOCUS-CASII criteria in Colorado

(April 9, 2026) Colorado providers will soon see an update to the evidence-based criteria used to support mental health level-of-care medical necessity reviews. Effective April 11, 2026, Evernorth Behavioral Health will adopt the Level of Care Utilization System (LOCUS) for customers aged 19 and older and the Child and Adolescent Level of Care/Service Intensity Utilization System (CALOCUS-CASII) criteria for customers aged 6 through 18.

Expanded in-network kidney care with Fresenius Medical Care effective January 1, 2026

(April 9, 2026) For many people living with kidney disease, the hardest part isn’t just treatment – it’s getting the right support at the right time, close to home. On January 1, 2026, patients enrolled in Cigna Healthcare plans began having greater in-network access to renal care through our strengthened partnership with Fresenius Medical Care (FME).

New tool to improve transparency into claim offsets and balances

(April 8, 2026) We’re introducing a new enhancement to the Cigna for Healthcare Professionals portal (CignaforHCP.com) – the negative balance report (NBR) – designed to give providers clearer, more timely insights into claim offsets.

Drug formulary updates effective July 1, 2026

(April 1, 2026) Effective July 1, 2026, Cigna Healthcare will make updates to its U.S. commercial drug formularies to support affordability, clinical appropriateness, and access. These formulary updates may change how some medications are covered for patients with Cigna Healthcare coverage, and affected patients may need assistance transitioning to covered, clinically appropriate alternative medications.

Updated Evernorth Behavioral Health Administrative Guidelines now available

(April 1, 2026) These guidelines, which are for contracted psychiatrists, psychologists, master’s-level therapists, hospitals, and facility-based programs, are reviewed annually to ensure the content remains relevant and current. A table summarizes the key updates.