UPDATE: Reprocessing of Certain Cigna Claims
Earlier this year, a few processing issues were identified with certain health insurance claims during the transition to Cigna as Duke’s plan administrator. Updates have been made to ensure claims were adjudicated as intended. The main areas impacted included MRI/CT/PET contrast charges, office/outpatient lab and X-ray services, and chemotherapy/infusion services in a physician’s office.
Cigna completed a review of all affected claims last month and has applied any necessary adjustments. As a result, providers will refund member overpayments as updated insurance payments are posted. If the overpayment involves Duke University Health System, refunds will be issued within 7–10 business days after the insurance payment is received.
If you believe your Explanation of Benefits (EOB) is incorrect, please contact Cigna Healthcare to request a claim review.
Effective January 1, 2026, Duke’s active employee health programs transitioned to Cigna as the new plan administrator. Duke Human Resources and Cigna are committed to this partnership to advance the health of plan participants while providing access to critical benefits and world-class care.
This page will provide updates on the transition as questions arise, as well as useful resources for members. Check back here next month for additional information about three upcoming Benefit Information Sessions (May 20, June 9, and June 24).
Important Contact Information
Cigna Healthcare Customer Service for Duke University Health
- Phone: 1-800-440-DUKE (3853)
- Email: dukeinquiry@cignahealthcare.com
MyCigna.com – access your health plan benefits and Cigna ID card
Common concerns that members could encounter as part of the transition to Cigna may include:
Confusion regarding member copays
In certain cases, an individual’s copay had not been accurately reflected within the Duke Health system when a provider used the verification platform in the electronic medical record to confirm benefits. This issue was resolved as of March 12. For additional questions or clarification of benefit coverage, contact Cigna Healthcare at (800) 440-3853. Benefits are also outlined on a member’s Cigna ID card.
Claims re-processing
As claims began to auto-adjudicate through Cigna, we made minor benefit edits to ensure claims were processed according to the Health Plan’s intent. The main areas impacted by these adjustments include MRI/CAT/PET contrasting charges, labwork/X-rays received in a physician’s office or outpatient facility, and chemotherapy and infusion charges received in a physician’s office. To be certain that claims have processed correctly, Cigna is reviewing these claims and will re-process any that are incorrect. Once a claim has been reprocessed and the insurance payment is received, the Health System will refund any overpayments with 7 to 10 days. If you believe your Explanation of Benefits (EOB) has been processed incorrectly, please reach out to Cigna Healthcare to ask them to review your claim.
Differences in medical policy criteria
In most cases, Cigna’s medical policy and clinical criteria aligns with that of our previous health plan administrators. However, some differences may occur that require additional documentation by your medical provider. Reach out to Cigna Healthcare if you encounter an issue with medical policy.
Service requirements for certain benefits
Certain benefits, such as infertility and bariatric surgery, require two years of continuous service before a member is eligible for services. Reach out to the HR Information Center (919-684-5600) if you believe you have met this requirement but are unable to access services.
Prior authorization (PA) status
In some cases (e.g., infusions and other pharmaceuticals administered through the medical plan), prior authorization (PA) from the previous health plan administrator did not fully transfer and additional documentation was needed for Cigna Healthcare to verify treatment needs. Prior authorizations have been updated, member claims have been adjusted, and ongoing issues should not occur. If you have questions related to prior authorizations, reach out to Cigna Healthcare. (Note: Duke’s prescription drug coverage through Express Scripts did not change).
Transition of Care/Continuity of Care
Members currently undergoing a course of treatment for a medical or behavioral health issue may be able to request Transition of Care to avoid a disruption to their treatment. Pregnancy, cancer, trauma, transplant, and behavioral health are examples of conditions that may qualify for continuity of care. Submit the Transition of Care request form to Cigna Healthcare if you feel you may qualify for continuity of care. (Note: members seeing an-out-of-network behavioral health care provider have been automatically granted continuity of care through March 31, 2026).
Access to Duke Health System providers
Members enrolled in Duke Select and Duke Basic have a health care provider network unique to Duke. All Duke Health System medical and behavioral health providers participate in the Duke custom network, though we are still working through the set-up of certain providers (e.g., audiology, lactation services). Reach out to Cigna at 1-800-440-DUKE (3853) if you have questions regarding your Duke provider’s network status or check the online provider directory: DUKE Select and DUKE Basic Custom Directory**
Behavioral Health Care
Some members may be seeing a behavioral health provider who does not participate in the Evernorth Behavioral Health network. For the first 90 days of the plan year (through March 31), Cigna processed out-of-network behavioral health visits as if these were in-network visits in order to give providers additional time to join the Evernorth Behavioral Health network or for members to find a participating provider. Almost 300 providers have joined the network since last June, and invitations to partner with Duke and Cigna are ongoing. Members may continue to nominate their providers for participation by submitting a request to Cigna Healthcare. All Duke plans include access to out-of-network behavioral health care, though some plans have day/visit limits that apply when out-of-network care is used. If you believe your out-of-network behavioral health claims were not processed as in-network, or if you incurred out-of-network claims that have not been submitted for reimbursement, reach out to Cigna Healthcare.
Member guides
Cigna Member Guides are being finalized and will be published in the coming weeks. If you have a specific question related to how a benefit will be illustrated in the member guide, please reach out to the HR Information Center (919-684-5600) to request assistance. You may also review the 2026 Summary of Benefits and Coverage published for each plan.
Care Management Services
Care management services are provided at no additional cost through DukeWELL and Cigna Healthcare. Members may self-refer to either group to gain assistance navigating complex medical conditions, coordinating care, and understanding treatment options. Contact DukeWELL at 919-660-WELL (9355) or Cigna Healthcare to request care management services.
Personal Health Coaching and Wellness Services
Wellness services such as health assessments, nutrition and fitness consultations, and other health support are provided through LIVE FOR LIFE and Duke CarePath Coaching (administered by Evernorth). Members may self-refer to either group, and most services are provided at no additional cost. Contact LiveForLife at 919-684-3136 opt. 1 and Duke CarePath Coaching at 919-339-2066.