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BLOGS
I Built Downcoding Defense Tools Nine Months Ago. This Week, NBC News Proved Why.
This article examines how Cigna Healthcare’s R49 policy and NBC News' recent investigation reveal a growing challenge for healthcare providers and how our Downcoding Defense Tools help practices stay compliant and protect their revenue.
Oct 145 min read
When Cigna R49 Claims Get Denied – Your Appeals Options
Starting October 1, 2025, Cigna Healthcare’s R49 downcoding policy is set to catch many practices off guard. These denials are not clerical mistakes; they’re part of a systemic tightening on higher-level E/M codes. Cigna Healthcare will not provide healthcare providers any notice; it happens automatically.
Sep 194 min read
The $50,000 Mistake: How Cigna’s R49 Policy Could Devastate Physician Practices
With only days left before October 1, physicians must understand what’s really at stake. A mid-sized practice that bills for 20 high-level visits per week could lose $4,000 to $5,000 per month if claims are downcoded. Over 12 months, this amounts to nearly $50K in lost reimbursements.
On October 1, 2025, Cigna Healthcare will enforce its new Evaluation and Management (E/M) Coding Accuracy (R49) Policy. This change is significant for many physicians; it represents a seismic s
Sep 166 min read
In fact, one healthcare provider we worked with achieved 132% of monthly collection goals.
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