According to the National Institute of Mental Health, Autism Spectrum Disorder (ASD) causes severe and pervasive impairment in thinking, feeling, language, and the ability to relate to others. This disorder is usually first diagnosed in early childhood. Our experience of working with providers and families has shown us that it’s necessary to have the right information, planning, resources and teamwork for the successful management of this illness. To best help parents and families of children living with this disorder, Cigna Behavioral Health has developed an educational program for autism. It includes comprehensive tools to help parents understand autism and to help providers monitor treatment progress.
Behavioral health services are available and covered for a variety of mental health and substance use disorders. For more information, visit Cigna's Autism Spectrum Disorder: Assessment and Treatment Coverage Policy.
Definition of Medical Necessity
Authorization may be required in some cases. Please call the number on the back of your patient's Cigna ID card to learn more about services and specialties covered under the benefit plan and/or determine if pre-authorization is required to complete treatment. Please follow the prompts to be connected to "Behavioral."
What can you expect in a clinical review?
- Timeframe - Clinical reviews are scheduled in 60-minute blocks, but generally take about 30 minutes to complete.
- Patient privacy - Each time you call Cigna, HIPAA verification will be necessary. Please be prepared with your Tax Identification Number (TIN) and the Cigna patient's:
- Date of birth
- ID number on the health benefit card
- Scheduling - Clinical reviews should be scheduled with a supervisor or the rendering health care provider on a case. Please do not schedule a review with a billing or office representative. Submit clinical documentation at least 24 hours prior to scheduled review.
To request an ABA assessment, please complete and submit the Applied Behavior Analysis (ABA) Assessment Request Form. If you have questions about other ABA services, call the Autism Case Coordinator Team at 1.877.279.7603.
For more information about the clinical review process, refer to our Clinical Review Guidelines. For your convenience, we've developed an Applied Behavior Analysis (ABA) Prior Authorization Form for your use in practice. The use of this tool is not required, but can serve as a resource to assist in the clinical review process.
Join Our Network
If you are a board certified behavior analyst and/or licensed mental health provider, learn more about joining our network.
Working with Cigna
To help you work most effectively with Cigna Behavioral Health, here is some important contact information:
|What is your need?||Contact:|
|Verify Applied Behavior Analysis benefits and eligibility||Call the Customer Service telephone number on the back of the Cigna patient's health benefit card|
|Request Applied Behavior Analysis prior authorization||Call the Autism Care Coordinator Team: 1.877.279.7603|
|For claims or other general questions||Call Provider Services:
For reimbursement of Applied Behavior Analysis therapies, Cigna utilizes CPT codes*. For more information about the best use of these codes, refer to our Billing Codes for Applied Behavior Analysis.
* Except in the Commonwealth of Pennsylvania.