Precertification

receptionist

PRECERTIFICATION GUIDELINES

Precertification can be complicated. Knowing the right place to start can make a big difference.

Below you will find when and where to submit precertification requests to Cigna and Cigna's national ancillary vendors for the following:

  • Medications
  • Medical
  • Behavioral

You'll also find answers to some of the most frequently asked questions related to precertification.


New process to order home health services for Cigna Commercial customers:

Contact participating home health, durable medical equipment, and home infusion therapy providers directly. CareCentrix no longer manages these services for Cigna. eviCore healthcare now administers these programs; however, approval or contact with eviCore is not needed.

To find a participating home health/DME provider:

  • Go to Cigna.com.
  • Click Find a doctor, dentist or facility.
  • Select the coverage option.
  • Enter address, city, or Zip Code
  • Click on ‘Health Facilities’
  • Enter the health care facility name or type (i.e. durable medical equipment or home health) or the provider’s name.

For more information, refer to:


Determine if precertification is required


Medical

View the complete list of services that require precertification of coverage:

Or, you can:

Not registered yet? Go to CignaforHCP.com and click on "Register Now."


Cigna Medicare Advantage

Please visit https://medicareproviders.cigna.com/ to view Cigna Medicare Advantage prior authorization requirements, including requirements for Arizona Medicare providers


Behavioral

View the authorization and billing resource for requirements.

Please note: Precertification of coverage is not required for emergency services. However, emergency services that result in an inpatient hospital admission must be reported within one business day of the admission unless dictated otherwise by state mandate.


Follow the service specific precertification process

Medications

To better serve our providers, business partners, and patients, the Cigna Coverage Review Department is transitioning from PromptPA™, fax, and phone coverage reviews, also called prior authorizations, to Electronic Prior Authorizations. ePAs save time and help patients receive their medications faster. Moving forward, please visit CoverMyMeds at www.covermymeds.com/main/prior-authorization-forms/cigna/ or via SureScripts in your EHR to learn more and submit all new PA requests electronically.

If you are unable to use electronic prior authorization, you can call us at 800.88Cigna (882.4462) to submit a prior authorization request.

EHR/EMR Online submission Questions

CoverMyMeds®

Surescripts®

Go to CoverMyMeds.com/epa/Cigna.

Not available

Call 866.452.5017

Call 866.797.3239

If you have used PromptPA in the past for prior authorization requests, please know we will no longer accommodate this tool in 2020, and you may receive the following message if you continue to use it: "Eligibility not found." Thus, we encourage you to use CoverMyMeds or Surescripts.

If you are unable to use electronic prior authorization, you can call us at 800.88Cigna (882.4462) to submit a prior authorization request.


Medical

There are a few ways to request precertification for medical procedures. Upon submission of a precertification request, please provide all required information. Failure to provide all necessary information required for the review may result in the denial of certification for an admission, procedure or service. To submit additional information to supplement a previously submitted precertification request, please submit via the original form of transmission.


For many services, we manage the precertification process directly:

  • Use your practice management system or vendor: Health Care Request and Response (ANSI 278) - Contact your Electronic Data Interchange (EDI) or Practice Management System vendor.
  • Fax 866-873-8279
  • Call 800.88Cigna (882.4462).

Behavioral

  • For Inpatient/partial hospitalization programs, call 800.926.2273
  • Submit the appropriate form for outpatient care precertifications. Visit the form center.

For the following services, we collaborate with national ancillaries to support the precertification process and administration of the services:

To request precertification, use the contact information below or visit the website for next steps.

Click the service type for more detailed information about each ancillary program and the services provided.

Durable medical equipment, home health and infusion Gastroenterology Integrated oncology management
eviCore healthcare
800.298.4806
Website
eviCore healthcare
844.457.9810
Website
eviCore healthcare
866.668.9250
Website

Musculoskeletal and pain management Radiation therapy Radiology imaging
eviCore healthcare
888.693.3297
Website
eviCore healthcare
866.668.9250
Website
High-technology and diagnostic cardiac imaging
eviCore healthcare

888.693.3297
Website

Sleep
eviCore healthcare
800.298.4806
Website


For the following services, we manage precertification (when required), and collaborate with national ancillaries to support the administration of the services:

Click on the service type for more detailed information about each ancillary program and the services provided.

When services do require precertification, please work with Cigna to obtain approval and then work directly with the ancillary to perform/receive the services.

National facilities that provide in-network services

National ancillaries that provide medical equipment

Dialysis

Davita

800.244.0680
Website
Laboratory**

LabCorp

888.LABCORP (888.522.2677)
Website
Fresenius
800.662.1237
Website
Quest Diagnostics
866.MyQuest (866.697.8378)
Website
Hearing

Amplifon Hearing Health Care

855.531.4695
Website
Orthotics and prosthetics

Linkia

877.754.6542
Website

**Our network of participating laboratories consists of an extensive choice of regional and national providers of laboratory services, including Laboratory Corporation of America (LabCorp) and Quest Diagnostics, Inc. (Quest). For a complete list of participating laboratories, please visit Cigna.com or CignaforHCP.com.


Frequently Asked Questions

Expand/Collapse All FAQs

What are the benefits of precertification?

Who has to request precertification?

Why is prior authorization needed for certain specialty medications?

What information do I need to have to request medication precertification?

How is predetermination different from precertification?

How do I submit a referral?

How do I know if my patient requires a referral?