A Cigna EOB is the document sent after a claim is processed, showing what was billed, what Cigna paid, and what the patient owes. The EOB is not a bill. It is a record of how the claim was adjudicated, including CARC codes, RARC codes, and payment adjustments.
Day 1: Claim submitted. Days 2-14: Claim adjudicated (standard timeline). Day of adjudication: Electronic EOB available on portal. Days 5-7 post-adjudication: Paper EOB mailed. Within 180 days of EOB: deadline to appeal any denied or underpaid line items.
| CARC Code | Reason | Primary Cause | Fix |
|---|---|---|---|
| CO-45 | Charges exceed fee schedule | Billed above contracted rate | Reference your Cigna contract fee schedule |
| PR-1 | Deductible not met | Patient has remaining deductible | Collect deductible at time of service |
| CO-97 | Benefit for this service included in another | Service bundled with another code | Review NCCI edits before billing |
If you disagree with the EOB, submit an appeal within 180 days from the denial or adjustment date. Include the EOB, clinical documentation, and a letter explaining the dispute. Submit through the Cigna provider portal or fax to the number listed on the EOB.
CARC codes appear in the Adjustment Reason column next to each line item. Common codes include CO-45 (fee schedule), PR-1 (deductible), and CO-97 (bundling). Each code links to a specific denial or adjustment reason.
Enroll in electronic remittance advice (ERA) through your clearinghouse or the Cigna provider portal. ERAs are delivered in the ANSI 835 format and post within 24 hours of adjudication.
Compare the allowed amount on the EOB against your Cigna contract rate. If underpaid, submit a payment dispute within 180 days. Include your contract rate schedule and the EOB showing the discrepancy.
Altair reads EOB data automatically and flags underpayments and denial patterns across all payers.