Cigna’s Hidden Changes Exposed: What Every Provider Needs to Know to Avoid Claim Denials 

In a sweeping move that impacts healthcare providers nationwide, Cigna has implemented updates requiring all diagnostic imaging services to obtain authorization through the EviCore portal. These changes, which affect cardiology, radiology, neurology, and other specialties, have led to widespread claim denials and created challenges for providers navigating the new requirements. We decided to explain the details of these updates, their implications, and actionable solutions for providers. 

The Scope of the Changes 

1. Mandatory Authorization Through EviCore 

Cigna now mandates that all providers offering diagnostic imaging services, including X-rays, ultrasounds, and mammography, secure authorization via the EviCore portal. Any claims submitted without this authorization face outright denial, regardless of the necessity or urgency of the imaging services provided. 

2. Credentialing Overhaul 

In addition to claim authorization, providers must update their existing credentialing setup through EviCore to continue offering imaging services. However, despite the significance of this change, there was no clear communication from Cigna alerting providers about the need for this sudden credentialing assessment in 2024. Providers were left in the dark, with no notifications on Cigna’s portal and minimal guidance from other channels. 

3. Limited Communication and Hidden Updates