At issue is a new rule, set to go into effect on May 25, requiring all providers to submit office notes with all claims including E/M codes 99212, 99213, 99214, and 99215 and modifier 25 when a minor procedure is billed. Cigna has provided no data or rationale to support the change, leading the healthcare organizations to question its intent and to propose alternative action. In a recent letter to Cigna CEO David Cordani, the groups stated, “Our organizations are alarmed at the significant administrative burdens and costs for healthcare professionals – and Cigna – that will result from implementation of this policy. About the American Chiropractic AssociationThe American Chiropractic Association (ACA) is the largest professional chiropractic organization in the United States. ACA attracts the most principled and accomplished chiropractors, who understand that it takes more to be called an ACA chiropractor.