CIGNA Life & Health Prior Authorization

CIGNA Life & Health 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’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