Stars Guidebook for Providers

AppendixHere are the CAHPS questions that you can directly affect:Here are the remaining CAHPS questions that contribute to Star measures:HEDIS measure abbreviationsStars Customer Summary Report abbreviations reference guideThis reference guide provides an explanation for each abbreviation that appears in the Stars Customer Summary Report and other Stars reporting.
Additional informationIf you have any questions, about Stars reporting, contact your Provider Performance Enablement representative.
How CMS measures Cigna Healthcare Medicare Advantage operations
Operational or administrative measures make up 21 percent of the overall 2026 Star rating.Administrative measures for Medicare Advantage plansCMS collects administrative data related to health plan service capabilities and performance through:Quality improvement measuresCMS measures a health plan’s or drug plan’s year-over-year improvement or decline through the quality improvement measures. The Part C and Part D improvement measures are derived through comparisons of a contract’s current and prior year scores for certain measures. For a measure to be included in the improvement calculation, the measure must not have had a significant specification change during those years.
Quality improvement measures may contribute up to approximately 10 percent of the overall 2026 Star rating.Claims submission: Procedure for 12+ diagnosis codesForm CMS-1500 and the X12-837P transaction (electronic format) allow providers to submit a maximum of 12 diagnosis codes in a single claim to report active chronic and acute diagnoses. However, there are times when you will want to report additional codes. The procedure is as follows:We encourage providers to submit additional codes, when supported by medical record documentation, because it will give CMS a more accurate picture of the breadth of services and treatments provided to patients, particularly for complex cases. In addition, it can impact quality reporting for CMS and HEDIS metrics, as well as diagnosis coding for risk adjustment.ProcedureFor 837P submissions, file a claim as you normally would, but be sure to include the following:

Use CPT code 99499 to populate loop 2400, sub-element SV101-2 of the X12-837P transaction. Populate additional diagnosis codes in loop 2300, HIxx-2 where HIxx-1 equals “ABK” or “ABF.”

Bill a zero-dollar claim.

Do not bill any other CPT codes on this supplemental diagnostic data claim.

Be sure the CLM05-3 Claim Frequency Type Code is set to 1 (original).

CoverContentsIntroduction to the CMS Five-Star Quality Rating SystemHow providers can raise Star ratingsSharing data improves accuracy and Star ratingsPharmacy measures can be a Star makerThe importance of patient follow-upsProvider group case studyClosing HEDIS-based care gaps virtually opens Stars improvement opportunitiesYour office staff can be Star generatorsDetails on how Stars are measuredCigna Healthcare works with you to raise Stars togetherFrequently asked questionsAppendixCigna