CIGNA Health and Life Insurance Company Prior Authorization

CIGNA Health and Life Insurance Company prior authorization rules are often service-specific rather than universal, so the safest workflow is to confirm the requirement in the payer's provider resources before scheduling or submitting care. The notes below summarize the most actionable provider-side guidance captured in the research set for this payer.

At a glance

• Cigna states that prior authorization/precertification requirements vary by plan and service. Official provider guidance says providers may submit medication prior authorizations through ePA portals such as EviCore by Evernorth, Surescripts, or CoverMyMeds; if ePA cannot be used, Cigna provides a phone number to submit a request. For behavioral health, emergency services do not require precertification, but inpatient admissions resulting from an emergency must be reported within one business day unless state law says otherwise. Cigna also states that missing required information can cause a request to be denied.
• Prior authorization requirements are plan- and service-specific.
• The official provider pages do not publish a single universal service list in the pages reviewed.
• Medication prior authorization workflows may differ from medical prior authorization workflows.

Where to verify prior authorization requirements

• Verification resource 1
• Verification resource 2

How to submit prior authorization requests

• Electronic prior authorization (ePA) portals

• EviCore by Evernorth

• Surescripts

• CoverMyMeds

• Phone submission when ePA is unavailable

• Submission resource 1

• Submission resource 2

• Submission resource 3

Information commonly required

• All required information for the precertification request
• Clinical details sufficient for the review
• Missing important details may result in denial

Turnaround notes and caveats

• Cigna’s general consumer-facing explanation says prior authorization responses are typically issued within 5 to 10 business days after receipt of the request.
• Emergency behavioral health services do not require precertification, but emergency inpatient admissions must be reported within one business day unless state mandate requires otherwise.
• Prior authorization requirements are plan- and service-specific.
• The official provider pages do not publish a single universal service list in the pages reviewed.
• Medication prior authorization workflows may differ from medical prior authorization workflows.

Provider resources

• Cigna for Health Care Professionals Online Portal (official)
• Claims Submission / When to File Claims (official)
• Precertifications and Prior Authorizations (official)
• Request for Health Care Professional Payment Review (official)
• EDI Electronic Claim Submission (official)
• Cigna Behavioral Health Claims Submission (official)
• Cigna Behavioral Health Getting Paid (official)

Sources