Nothing makes a behavioral health provider’s stomach drop quite like the phrase “Cigna audit”. This formal review process can feel intimidating and overwhelming, like a surprise pop quiz—only in this case, the teacher is holding your paycheck. But here’s the good news: you can survive a Cigna audit in one piece. With the right preparation and support, you can turn what feels like a nightmare into just another part of running your practice.

At Integrity Billing, we work with behavioral health facilities every day, helping them navigate payor audits, recover lost revenue, and stay compliant. Here’s what you need to know.

Why Am I Being Audited?

First things first—don’t take it personally. A Cigna audit doesn’t automatically mean you’ve done something wrong or that your practice is under suspicion. In most cases, it’s part of the insurer’s routine process to verify that claims are accurate and supported. Think of it as a system of checks and balances: Cigna wants to confirm that the services billed were actually provided, that they were medically necessary, and that the documentation matches the codes submitted.

Sometimes audits are random, like drawing straws. Other times, they may be triggered by patterns in billing, such as frequent use of certain codes, higher-than-average claim amounts, or even missing documentation. In other words, an audit may happen because of the way the data looks, not because you or your team made a mistake.

The important thing to remember is this: audits are less like a detective movie and more like a medical check-up. They might be uncomfortable and inconvenient, but they’re a way of ensuring the system stays healthy. Granted, they’re not as fun as leaving the doctor’s office with a lollipop, but with the right preparation, they don’t have to be a disaster either.

Step One: Don’t Panic

Easier said than done, right? But panicking won’t make the audit go away. The best thing you can do is stay calm and start organizing. That means pulling together the documentation Cigna is most likely to request, such as treatment notes, signed and updated treatment plans, intake assessments, billing records, and prior authorizations.

It also helps to make sure your files are complete, legible, and easy to follow. When records are neatly organized, reviewers can see at a glance that the services billed match the care provided, which makes the process smoother for everyone.

Take the audit request seriously, but remember, this is survivable. Many providers have been through it before and come out just fine.

Step Two: Get Your Documentation in Order

Cigna will likely request clinical records, treatment notes, and billing documentation during an audit. This is where thorough and accurate recordkeeping becomes your best friend. If the documentation clearly supports the services you billed, you’re already in a strong position.

To prepare, make sure progress notes align with the services billed, confirm that all required authorizations are on file, and ensure treatment plans are properly signed, dated, and updated as needed. If you’ve been keeping up with compliance along the way, this step becomes less of a scramble and more of a straightforward “gather and send” exercise.

Step Three: Respond Promptly (and Professionally)

Deadlines matter. Delayed responses can create red flags or lead to claim denials, and no one wants to lose reimbursement over a missed date. The best approach is to treat the audit request like a priority project. Make sure your submission is complete, organized, and sent in on time.

Double-check your records before sending so nothing important slips through the cracks. If something in the request is unclear, don’t hesitate to reach out for clarification. Insurance companies may not be known for their sparkling customer service, but asking the right questions upfront can save you major headaches down the road.

Clear communication also shows that you’re taking the process seriously, which can help the audit move along more smoothly.

Step Four: Learn From the Process

Once the audit is complete, review the results carefully. Even if everything checks out, there may be areas where your documentation or processes could be improved. Think of it as free feedback (okay, maybe free isn’t the word you’d choose, but you get the idea).

An audit can highlight gaps you didn’t know existed, like progress notes that need more detail, treatment plans that could be updated more consistently, or billing workflows that could use tightening. Instead of seeing it as criticism, view it as an opportunity to strengthen your systems and make future audits less stressful.

The truth is, every audit is a learning experience, and the more you take from it now, the better prepared you’ll be the next time one comes around.

Where Integrity Billing Comes In

Here’s the thing: surviving a Cigna audit doesn’t mean you have to do it alone. At Integrity Billing, we help behavioral health providers prepare for and navigate audits, manage compliance, and strengthen their revenue cycle so surprises are less disruptive.

Our team knows the ins and outs of payer audits and can step in to support you before, during, and after the process. Because at the end of the day, your focus should be on patient care, not wrestling with insurance paperwork.

Stay Ahead of a Cigna Audit by Staying Organized

A Cigna audit might not be the highlight of your year, but it doesn’t have to derail your practice either. With preparation, organization, and the right support, you can come out on the other side with your sanity intact.

Facing an audit? Integrity Billing is here to help you keep your revenue cycle strong and your focus on the people you serve. Give us a call today at 800-683-5640 or fill out our contact form to learn how we can support your practice.