CIGNA Health and Life Insurance Company Timely Filing Limit

The most important thing to confirm with CIGNA Health and Life Insurance Company is not just the number of days, but also what event starts the clock. Some payer documents measure from date of service, some from discharge, and some publish different rules for corrected claims or appeals.

At a glance

• For claims submitted directly to Cigna, the official provider guidance states participating provider claims are timely if submitted within 90 days from the date of service, while out-of-network claims are timely if submitted within 180 days from the date of service. For consecutive-day services such as a hospital confinement, the period is counted from the last date of service. Cigna Behavioral Health materials separately state that individual professionals should submit within 180 days of the date of service and facilities within 180 days of discharge, with an exception when it was not reasonably possible to file sooner and the claim is submitted as soon as reasonably possible.

Initial claim filing limits

• Participating provider claims: 90 days from date of service
• Out-of-network claims: 180 days from date of service
• Cigna Behavioral Health individual professional claims: 180 days from date of service
• Cigna Behavioral Health facility claims: 180 days from discharge

Corrected claim filing limits

• If a claim was timely filed originally but Cigna requested additional information, resubmission is treated differently and the filing limit may not apply in the same way.
• Corrected claims should be sent to the claim address on the back of the patient’s Cigna ID card.

Appeal and reconsideration deadlines

• Health care professional appeal requests should be submitted within 180 days, with 60 days allowed for processing unless other timelines are required by contract or state law.

Trigger basis and caveats

• Direct-to-Cigna claims use date of service timing.
• For consecutive-day services, the timing is counted from the last date of service.
• In coordination of benefits situations, timing may be measured from the primary payer’s EOB/EOP processing date.
• Some behavioral health materials use discharge date for facilities.
• Timely filing rules can vary by provider agreement, line of business, and state law.
• The Cigna Behavioral Health pages reviewed are older and may not reflect every current operational exception.
• Appeal timing is not the same as claim filing timing.

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