CIGNA Life & Health Prior Authorization

CIGNA Life & Health publishes service-specific prior authorization guidance. Start with the payer resource below, then confirm the member's plan and the requested service before care is scheduled or submitted.

At a glance

• Cigna’s official provider pages direct providers to the precertification/preauthorization resources in the provider portal and note that requirements can vary by plan, state law, and line of business. I found general submission guidance but not a single universal prior-authorization rule set that applies to all Cigna products.
• Prior authorization/precertification rules vary by line of business and by plan.
• The official pages reviewed point to portal resources rather than listing a universal procedure for all products.
• Use the patient’s ID card and portal for the operative authorization instructions.

Where to verify prior authorization requirements

• Verification resource 1
• Verification resource 2

How to submit prior authorization requests

• Use the Cigna for Health Care Professionals portal for precertification/preauthorization workflows

• Follow plan-specific instructions on the member ID card or in the provider portal

• For some behavioral/shared-administration arrangements, follow the claims/precertification routing in the member ID card or manual

• Submission resource 1

• Submission resource 2

Information commonly required

• Plan- and product-specific authorization details
• Supporting clinical documentation when requested
• Patient/member identification and claim/service details as applicable

Turnaround notes and caveats

• No single universal turnaround time was located on the official pages reviewed.
• Cigna notes that state legislation and/or plan-specific language can supersede administrative guidelines.
• For appeals-related review, Cigna states 60 days for the review and 75 business days for dispute resolution notification, but that is appeals timing rather than prior authorization timing.
• Prior authorization/precertification rules vary by line of business and by plan.
• The official pages reviewed point to portal resources rather than listing a universal procedure for all products.
• Use the patient’s ID card and portal for the operative authorization instructions.

Provider resources

• Cigna for Health Care Professionals portal (official)
• Submit and Pay Claims for Providers (official)
• Appeals and Disputes (official)
• Cigna contact numbers / claims mailing address (official)
• Evernorth Behavioral Administrative Guidelines (official)

Sources