Skip to main navigation Skip to main content Skip to footer For Individuals & Families For Medicare For Brokers For Employers Español For Providers: For Providers Credentialing Overview Medical Credentialing Dental Credentialing Behavioral Credentialing Coverage and Claims Overview Claims Prior Authorizations Coverage Policies Appeals and Disputes Payments Pharmacy Overview Formulary Drug Lists Medicare Part D Pharmacy Management Provider Resources Overview The Body and Mind Connection Cultural Competency and Health Equity Programs for Patients Medicare Providers Cigna Network News for Providers Log in to CignaforHCP
Home Providers Coverage and Claims Submit a ClaimClean Claim Requirements

Clean Claim Requirements

Make sure claims have all required information before submitting.

What is a Clean Claim?

At Cigna HealthcareSM, our goal is to process all claims at initial submission. Before we can process a claim, it must be a "clean" or complete claim submission, which includes the following information, when applicable:

  • primary carrier explanation of benefits (EOB) when Cigna Healthcare is the secondary payer
  • prescription for physical therapy
  • itemization of dates for physical therapy from facility
  • prosthesis invoice
  • trip notes for ambulance transport
  • standard Diagnostic Related Groupings (DRG) or Revenue codes (facility)
  • standard Health Care Procedure Coding System (HCPCS) code sets and modifiers
  • standard Current Procedural Terminology (CPT®) code sets and modifiers
  • standard International Classification of Diseases (ICD-10) codes, tenth revision
  • accurate entries for all the fields of information contained in the UB04 [PDF]1 or CMS-1500 forms [PDF]1

The following modifiers do not require clinical records: CPT modifiers 26, 52, 63, or 90

Claims Requiring Clinical Documentation

Except as noted, we routinely require clinical documentation at the time a claim is submitted for the following categories of claims to be considered complete:

  • codes to which an assistant surgeon modifier (80, 81, or 82), assistant-at-surgery modifier (AS), or co-surgeon modifier (62) is attached that do not normally require surgical assistance or co-surgeons
  • an 'unlisted code' as defined in the Index of CPT under 'Unlisted Services and Procedures'
  • a code that is not otherwise specified (NOS)
  • a code that is not otherwise classified (NOC)
  • procedures that are potentially cosmetic
  • procedures that may be experimental/investigational/unproven
  • procedures that are medically necessary for some indications and not for others
  • services performed in an unexpected place of service, such as office services performed in an outpatient surgery center
  • codes appended with a modifier indicating additional or unusual services (e.g., 22, 23, 24, 53, 59, or 66)
  • modifier 25 - Evaluation & Management (E/M) service codes that disallow with a CMS/NCCI Incidental Edit (also called Column 1/Column 2 Code Edits) designated by CMS as '1'1
  • modifier 59 - Non-Evaluation & Management (E/M) service codes that disallow with a CMS/NCCI Mutually Exclusive Edit designated by CMS as '1'1

The supporting documentation requirement is on selected code edits when modifier 25 or 59 is billed. It is not an across the board requirement for all uses of these modifiers. A specific list of Cigna Healthcare combinations that require documentation is available on the Cigna for Health Care Professionals website at To view, click on 'Resources Claim Editing Procedures.'

Types of clinical documentation that may be requested include:

  • emergency room notes
  • facility notes
  • anesthesia notes and time
  • facility/MD notes
  • operative notes
  • radiology interpretation and report
  • lab results
  • MD office notes

This policy is not designed to limit our right to require submission of medical records for precertification purposes.2

Editing Claims with Cigna Healthcare

ClaimsXten Clear Claim ConnectionTM, our code edit disclosure tool powered by McKesson, allows users to enter CPT and HCPCS coding scenarios and to immediately view the audit result. Clinical edit rationales, as well as edit sourcing, are provided for any code that is not allowed in Clear Claim Connection.

Clear Claim Connection is accessible through the Cigna for Health Care Providers portal at Once logged on, you may review the Clear Claim Connection Frequently Asked Questions for more information.

Cigna Healthcare is committed to providing solutions that can minimize your administrative costs while helping to reduce the complexity of doing business with us.

Claim Forms

UB04 [PDF] CMS1500 form [PDF] Dental Claim form [PDF]

More on Claims provider portal

Back to Coverage and Claims

Claims processing will not be delayed when the submission of supporting documentation is indicated in box 19 of the electronic claim submission or when attached to a paper claim. When supporting documentation is indicated on an electronic claim submission, the supporting documentation can be mailed to Cigna Healthcare address on the back of the patient identification card.

State legislation and/or plan-specific language supersede Cigna Healthcare administrative guidelines.

Page Footer

I want to...

Get an ID card File a claim View my claims and EOBs Check coverage under my plan See prescription drug list Find an in-network doctor, dentist, or facility Find a form Find 1095-B tax form information View the Cigna Glossary Contact Cigna


Individuals and Families Medicare Employers Brokers Providers

Secure Member Sites

myCigna member portal Health Care Provider portal Cigna for Employers Client Resource Portal Cigna for Brokers

The Cigna Group Information

About Cigna Healthcare Company Profile Careers Newsroom Investors Suppliers The Cigna Group Third Party Administrators International Evernorth

 Cigna. All rights reserved.

Privacy Legal Product Disclosures Cigna Company Names Customer Rights Accessibility Report Fraud Sitemap Cookie Settings


Individual and family medical and dental insurance plans are insured by Cigna Health and Life Insurance Company (CHLIC), Cigna HealthCare of Arizona, Inc., Cigna HealthCare of Illinois, Inc., Cigna HealthCare of Georgia, Inc., Cigna HealthCare of North Carolina, Inc., Cigna HealthCare of South Carolina, Inc., and Cigna HealthCare of Texas, Inc. Group health insurance and health benefit plans are insured or administered by CHLIC, Connecticut General Life Insurance Company (CGLIC), or their affiliates (see a listing of the legal entities that insure or administer group HMO, dental HMO, and other products or services in your state). Accidental Injury, Critical Illness, and Hospital Care plans or insurance policies are distributed exclusively by or through operating subsidiaries of Cigna Corporation, are administered by Cigna Health and Life Insurance Company, and are insured by either (i) Cigna Health and Life Insurance Company (Bloomfield, CT); (ii) Life Insurance Company of North America (“LINA”) (Philadelphia, PA); or (iii) New York Life Group Insurance Company of NY (“NYLGICNY”) (New York, NY), formerly known as Cigna Life Insurance Company of New York. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna.

All insurance policies and group benefit plans contain exclusions and limitations. For availability, costs and complete details of coverage, contact a licensed agent or Cigna sales representative. This website is not intended for residents of New Mexico.

Selecting these links will take you away from to another website, which may be a non-Cigna website. Cigna may not control the content or links of non-Cigna websites. Details