Notes · reference

Cigna payer profile for Florida practices: timely filing, appeals, prior authorization, recoupment (2026)

Clearia · October 2026 · payer profiles

Last verified against the primary documents: October 26, 2026. Statutes, rules, and payer policies change; the current text controls.

For Cigna Healthcare commercial plans, participating providers file within 90 days of the date of service, appeal within 180 calendar days of the payment or denial notice, and mail appeals to the Cigna Appeals Unit, PO Box 188011, Chattanooga, TN 37422. On fully insured Florida policies, section 627.6131 adds its own limits on overpayment recovery.

This profile covers Cigna Healthcare commercial plans as they apply to Florida providers. Medicare Advantage plans run on separate rules and are out of scope. Every rule below links to the Cigna page, form, or statute it comes from. Cigna's full medical reference guide sits behind the provider login, so where the public pages are silent, we say so rather than fill the gap.

One caution first. Cigna's own pages say its filing and appeal time limits are subject to applicable law and to your provider agreement. Your agreement sits above every sentence below. Read the two together.

1. Claims: filing limits, submission, and corrections

Timely filing

Cigna's When to File page sets the limits:

• Participating providers: three months (90 days) after the date of service.
• Out-of-network providers: six months (180 days) after the date of service.
• Consecutive days of service, such as a hospital stay: the limit counts from the last date of service.
• Exceptions listed by Cigna: applicable law requires a longer filing period; the provider agreement allows more time; coordination of benefits; and a claim that was filed on time but where Cigna requested more information.

Two practical points. First, the same page says a resubmission that Cigna did not request, and that is not filed as an appeal, is still subject to the filing limit. A corrected claim sent on day 100 can fail on timeliness even if the original went in on day 10. Second, Cigna's claims submission page says your contract prohibits balance billing the patient when a claim is denied for late filing. A missed deadline is a write-off, not a patient balance.

Florida law sets its own period. For fully insured major medical policies, section 627.6131(3)(b) provides that a claim must be mailed or electronically transferred within 6 months after the date of service for outpatient services, once the provider has the insurer's correct name and address. Cigna's page itself makes an exception where law requires a longer period. The working rule is still simple: file inside 90 days, and if a fully insured claim is refused as late between day 91 and six months, raise the statute. Florida's statutory filing floors, quoted. What still wins on a CO-29 timely filing denial. How Cigna's limit compares with Medicare, Florida Blue, UnitedHealthcare and Aetna: timely filing limits by payer.

Submission

Cigna's electronic claim submission guide for medical and behavioral providers gives payer ID 62308 for medical claims, and says primary and secondary claims can both be sent electronically. For paper, use the claim address on the back of the patient's ID card. Cigna's payment review form directs corrected claims, and first-time payment reviews of claims with no payment yet, to that card address.

Corrected claims

The same EDI guide sets the mechanics. A corrected claim carries claim frequency code 7 (replacement of a prior claim) or 8 (void or cancellation of a prior claim), which lets Cigna recognize it as a correction instead of a duplicate. Electronically the code sits in loop 2300, CLM05. On paper it goes in Box 22 of the CMS-1500 with the original claim number, or in the third position of the type of bill on the UB-04.

Corrections do not go through the appeals unit, and they do not go through the online reconsideration tool either. Cigna's online reconsideration guide says so directly: corrections to a claim cannot be submitted through it.

2. Reconsiderations and appeals

The steps

Cigna's Request for Health Care Professional Payment Review form lays out three steps:

1. Call first. "Contact Cigna Customer Service at the toll-free number listed on the back of the patient's Cigna ID card to review any adverse determinations/payment reductions." If the representative cannot change the decision, you are told of your right to appeal.
2. Send the form or a letter with everything attached. "Your appeal should be submitted within 180 days and allow 60 days for processing your appeal, unless other timelines are required by state law." Include the completed form or an appeal letter stating why the payment is incorrect, a copy of the original claim, and the EOP or EOB. For clinical denials (medical necessity, level of care, no prior authorization), add a narrative, the operative report, and medical records.
3. Mail to the address for the patient's card. Cigna Appeals Unit, PO Box 188011, Chattanooga, TN 37422. If the ID card shows GWH-Cigna or a "G" on the front: Cigna Appeals Unit, P.O. Box 188062, Chattanooga, TN 37422-8062.

The form's own issue list is a useful map of what Cigna treats as appealable: bundling and mutually exclusive code denials, your contract and fee schedule terms, modifier reimbursement, medical necessity, timely filing, no precertification, and the maximum reimbursable amount, among others.

The deadline

Cigna's appeals and disputes policy page states the window: 180 calendar days from the date of the initial payment or denial notice or, where Cigna adjusted the payment, 180 calendar days from the date of the last payment adjustment. Cigna's appeal policy page for health care professionals describes a single-level internal appeal, reviewed by someone not involved in the initial decision, completed in 60 days. After that, arbitration may be the binding final step where the provider agreement requires it; the appeals page says arbitration of a payment dispute must be requested within one year of the letter communicating the final internal decision.

Plan for one complete submission. If the internal appeal is the only internal level, the first package is the one that gets reviewed. Cigna's 180 days next to the other Florida payers' appeal windows.

Online reconsideration

Cigna's step-by-step guide covers requests started from the claim on CignaforHCP. The claim must be finalized (paid, denied, processed, or duplicate) for the button to appear. Only one request can be open on a claim at a time, and the decision shows under the claim's reconsideration history. It is a quick route for straightforward fixes. Keep the written appeal for anything that needs records.

Underpayments on fully insured plans

For paid-but-short claims on fully insured Florida policies, section 627.6131(19) gives physicians 12 months after the insurer's payment of the claim to submit a claim for underpayment. That window runs longer than the 180-day contractual appeal. Florida's 12-month underpayment rule, explained. Florida also runs a statewide claim dispute program under section 408.7057; how those disputes have ended, by payer.

3. Prior authorization for ortho, spine, and pain

Cigna's precertification page sends musculoskeletal pain management, joint surgery, and spinal-related procedures to eviCore. Cigna's musculoskeletal and spine surgery management program page sets who is in scope:

• All Cigna Healthcare customers receiving these services in an inpatient setting.
• Customers receiving them in the outpatient setting whose ID card identifies that precertification is required for outpatient procedures.

Where to check a specific code: the commercial code lists for interventional pain management, joint surgery, and spine surgery are posted on eviCore's Cigna provider resources page, and Cigna's broader Master Precertification List covers the rest. Read the ID card at intake. It decides whether an outpatient injection or arthroscopy needs eviCore before the date of service.

When a claim is denied for no authorization and one existed, the authorization number goes in the appeal with the claim. What to check when an authorized claim is denied anyway.

4. The R49 E/M coding accuracy policy

Cigna's reimbursement policy R49, Evaluation and Management Coding Accuracy, applies to professional claims on the CMS-1500 or its electronic equivalent. Its core sentence: Cigna "may adjust the E/M CPT code 99204-99205, 99214-99215, 99244-99245 to a single level lower when the encounter criteria on the claim does not support the higher-level E/M CPT code reported." Cigna's July 2025 policy update announced it as a new policy effective October 1, 2025.

What the policy says about getting the level back: when a code level has been adjusted and medical records are later submitted that substantiate the complexity and medical decision making, or the time, of the reported level, "the code will be reimbursed at the level initially submitted." Claims for children under one, certain transplants, and certain complex conditions are excluded, as are claims from behavioral health providers.

What a practice should do:

• Document to the AMA CPT E/M guidelines, which R49 itself points to: medical decision making or total time, stated in the note, for every 99204 to 99205 and 99214 to 99215.
• Watch the 835. An adjusted line shows the code paid next to the code billed. Your posting system usually reads only the first. How to find 99214s paid as 99213s.
• Dispute with records, inside 180 days. Send the visit note with the payment review form, checking "Other" and naming R49 as the issue, to the appeals address for the card.
• Check the current version. The policy PDF lists an annual review date of October 1, 2026. Confirm its status on Cigna's site before you rely on it.

5. Overpayment recovery in Florida

Cigna's commercial recovery terms live in the reference guide behind the provider login and in your agreement. For fully insured Florida policies, the statute sets the outer limits, whatever the guide says. From section 627.6131:

• A written basis. The insurer's overpayment claim must come with a written or electronic statement specifying the basis for the retroactive denial or payment adjustment, and must identify the claims (subsection (6)).
• Lookback. For physicians licensed under chapters 458 and 459, overpayment claims must be submitted to the provider within 12 months after the insurer's payment of the claim, absent a fraud conviction (subsection (18)).
• Your clock. The provider has 40 days after receipt to pay, deny, or contest. A denial or contest must be in writing within 35 days, identifying the contested portion and the reason (subsection (6)(a)).
• No offset without consent or silence. "The health insurer may not reduce payment to the provider for other services unless the provider agrees to the reduction in writing or fails to respond to the health insurer's overpayment claim as required by this paragraph" (subsection (6)(a)3).

The practical rule: answer every Cigna overpayment letter in writing within 35 days, even when you agree with part of it. A timely written contest keeps the disputed amount from being netted against other claims. Note what the statute covers: fully insured policies issued under the Florida Insurance Code (subsection (15)). Self-funded employer plans that Cigna administers fall outside it, so check each plan's funding type before citing the section. Recoupment rules in Florida, and when to say no.

6. Secondary claims

When Cigna is secondary, send the claim after the primary payer finalizes. Cigna's EDI guide says secondary claims can go electronically under payer ID 62308, with the primary payer's ERA or EOP information entered on the claim. Cigna's When to File page lists coordination of benefits as an exception to the standard filing limit. On fully insured Florida policies, section 627.6131(3)(b) gives 90 days after the primary insurer's final determination for the claim to the secondary. The CO-22 coordination of benefits denial and its fix.

7. Remittances and payment

Cigna's electronic remittance advice page says ERA enrollment runs through your EDI vendor, which sends the enrollment to Cigna, and Cigna finalizes registration within 10 business days of receiving it. Electronic funds transfer is enrolled separately, through CAQH or on CignaforHCP. Cigna's public pages that we reviewed do not state a payment cycle frequency for commercial claims. The 835 is where you will see adjusted E/M levels and any recovery offsets, so load it, do not just post the check. The 835 fields that show an underpayment.

8. The Cigna checklist

1. Read the ID card at intake: plan type, the claim address on the back, the appeal address marker (GWH-Cigna or "G"), and whether outpatient precertification is required.
2. File every claim inside 90 days of the date of service. Keep the clearinghouse acceptance report.
3. Send corrections with frequency code 7 or 8 and the original claim number, to the claim address, inside the filing limit.
4. Get eviCore authorization for spine, joint, and pain procedures when the card or the code list calls for it.
5. Date every appeal from the payment or denial notice: 180 calendar days. Call first, then send one complete package with the claim, the EOP, and the records.
6. Check every 99204 to 99205 and 99214 to 99215 line on the 835 for a paid code one level lower. Dispute with the note.
7. Answer overpayment letters in writing within 35 days on fully insured plans.
8. Sort Cigna claims by funding type. Florida's statutory limits apply to the fully insured ones.

• 2026-10-26: First published. Each Cigna rule checked against the Cigna page or form linked beside it; Florida provisions against the 2025 Senate print.