If you submit claims through electronic data interchange (EDI) using the 837 transaction, you already benefit from a fast, efficient process that supports timely adjudication. Building on that foundation, Cigna Healthcare^® will soon release an enhancement that flags certain billing errors at the time of submission, allowing you to correct issues earlier in the claims process and helping to reduce post-adjudication denials.

What’s new?

Effective July 1, 2026, claims that include an unacceptable primary diagnosis (as defined under existing reimbursement policy¹ and ICD-10-CM² guidelines) may be returned at the point of submission for correction ‒ rather than being processed through post-adjudication. Please note that a rejection is not a payment decision – it simply means the claim needs to be corrected before it can be processed. This allows you to correct and resubmit the claim before adjudication begins.

This change applies to claims you submit on or after July 1, 2026, for dates of service January 1, 2026, and forward.

Identifying and correcting the claim at submission can help you:

• Reduce rework and rebilling associated with post‑adjudication claim corrections.
• Support more streamlined administrative workflows.
• Support quicker issue identification and more predictable payment timelines.
• Reduce time spent on administrative follow-up, allowing greater focus on patient care.

Preparing for the update

To help support a smooth transition, we recommend that you:

• Review your claims workflows to ensure your systems can recognize and respond to point-of-submission rejections. Rejections will be returned through the 277CA response – which most practice management systems and clearinghouses already display – so you can quickly and easily correct and resubmit claims.

What you’ll see: The applicable rejection codes are A7 and 255. The corresponding message language is: “The submitted primary diagnosis code is invalid for claim adjudication. Per ICD-10-CM guidelines, codes for manifestations, external causes, sequelae, or “code first” conditions cannot be primary. Please review and submit a valid code.” This message will appear alongside any other standard EDI edits returned at submission.

• Educate billing and administrative staff so unacceptable primary diagnoses (as defined under existing reimbursement policy) can be identified and corrected prior to claim submission.
• Contact your clearinghouse if you have questions, as clearinghouses have been notified of this update.  

Where to find information on unacceptable primary diagnosis codes

Information regarding unacceptable primary diagnosis codes is available in the Unacceptable Primary/Principal Diagnosis Reimbursement Policy – (R38). To access the policy, log in to the Cigna for Health Care Professionals portal (CignaforHCP.com) > Resources > Clinical Reimbursement Policies and Payment Policies > Reimbursement and Modifier Policies> Reimbursement and Modifier Policies – Commercial > Unacceptable Primary/Principal Diagnosis Reimbursement Policy – (R38).

1 Unacceptable Primary/Principal Diagnosis Reimbursement Policy – (R38).

2 International Classification of Diseases, 10th Revision, Clinical Modification.