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Cigna

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Cigna

Overview

Commercial health insurance payer. Operationally entangled with Evernorth for behavioral health, creating routing ambiguity. Medallion historically routed some specialties to ASH (American Specialty Health) — this is being corrected. Cigna’s Medicare Advantage arm was previously branded Cigna Healthspring; it rebranded to standalone Healthspring with a separate enrollment flow — treat as a distinct payer for submissions.

Active Work / Processes

Standard call flow

  1. Call Cigna → choose credentialing option → national contracts
  2. For “other states to enroll in,” tell rep and request a note asking for a national contract

Group-size rules

  • 5+ providers: submit a group roster first; do NOT initiate individual credentialing.
  • In-network provider linking to an in-network group: send link letter to intake_pdm (no new credentialing needed).

Routing rule

  • Do NOT route to ASH. If a Cigna rep redirects to ASH, push back: state “we’re a multi-specialty group, we always go through Cigna” and request transfer back to Cigna. Medallion’s Cigna project plan is being revised to remove ASH routing instructions entirely.

Pain Points / Open Issues

  • National vs state-specific contract confusion — Cortica signed a new national Cigna contract Nov 2025; Medallion’s enrollments may not be acknowledging the new contract, causing stalled submissions. (74 processing, 7 needs-client-attention for Cortica as of 2026-04-16.)
  • NC stalled: 1 of 19 Cortica providers enrolled since Nov 2025 contract. Cigna has not responded to roster inquiries Cortica has sent since February.
  • Behavioral-health routing ambiguity: Cortica’s behavioral-health providers were negotiated inside the Cigna contract (not Evernorth), but behavioral health normally auto-routes through Evernorth — may cause mis-routing.
  • Application accuracy issues — Sarah reviewing Cortica’s Cigna apps: both group and individual pages filled simultaneously, providers listed as PCPs incorrectly.
  • Sarah’s observation: “signal [Cigna] reps make a lot of mistakes and Medallion isn’t pushing back on them.” Medallion’s new QC/QA mailbox-review step is addressing this.

Key Facts

  • National contracts are multi-state; for some customers, behavioral health is negotiated inside the Cigna contract rather than Evernorth.
  • Large-group rostering required before credentialing for 5+ providers.
  • Cortica
  • Confluent — Healthspring (formerly Cigna Healthspring) rebrand surfaced in 4/15 weekly; contracting exploring a national-roster Healthspring contract.

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