As part of our quality improvement program, and to comply with state-specific requirements, Cigna conducts Ambulatory Medical Record Reviews (AMRR) for providers in select markets. Your contract with Cigna Healthcare requires your participation in the Cigna Healthcare Quality Program. Non-adherence with Program requirements may lead to disciplinary actions, including corrective action plans or termination, consistent with applicable law and your contract with Cigna Healthcare.

AMRR evaluates medical records but does not define standards of care or replace the clinical judgment of treating providers.

• Selection - A random sample of medical records are selected from participating primary care-type providers who have more than 30 Cigna customers as patients. Providers receive a notification letter from Cigna when they are selected to participate in the review. The medical record documentation requested for the review may be submitted securely by fax. Cigna's Quality Programs and Accreditation Department staff will work with you and your office staff to facilitate access to the record samples designated for review.


• Documentation - Medical records should be current, detailed and organized to ensure Cigna customers receive effective, safe, and confidential care. Medical records should include:


• Updated, complete problem list or summary of health maintenance exams
• Current prescription medication list or medication notes
• Documentation of allergies and adverse reactions to medication
• Past Medical history
• Exam coinciding with chief complaint including subjective and objective findings
• Documentation of treatment plan consistent with the diagnosis
• Review of lab and diagnostic studies
• A recommendation for follow-up at each visit
• Review of consultative reports
• Follow-up on prior problem addressed at each visit
• Discussions about Advance Directive
• Screenings for tobacco and alcohol usage

Other Important Information

• Confidentiality - Providers are asked to maintain confidentiality practices around secure storage of medical records, easy retrieval, and access to records by authorized personnel and periodic training of staff. Providers must maintain confidentiality for all medical records and treatment information in accordance with state and federal law. For some states, Cigna may request an attestation to be signed and returned along with the requested medical record documentation to confirm that the confidentiality and privacy requirements are being met.
• Goals - Performance goals are established by our Quality Management Committee and serve as the benchmark for quality medical records.
• Cigna uses a collaborative approach to conduct medical record reviews and offers opportunities for improvement for physician practices to assist in increasing the overall performance score when performance goals are not met.

The following best practices have been identified and are associated with complete medical record documentation:

• The use of an electronic medical record documentation system, that addresses all important aspects of care (i.e., allergies, adverse reactions and instructions for follow up care), improves legibility (with fewer errors and omissions), patient safety and continuity of care.
• Medication allergies and adverse reactions are prominently noted in the record. If there are no known allergies or history of adverse reactions, this is appropriately noted in the record.
• The use of pre-printed or downloadable chronic care management tools for tracking assessments, planning and follow-up needs from medical associations, serves as a quick guide for overall disease management and treatment goals.
• The use of a Problem List/Health Maintenance tool updated regularly with medications, patient and family history improves patient care management and safety.