Gastroenterology Program
Cigna works with eviCore healthcare (evicore) to administer a precertification program for Cigna customers for the gastroenterology procedures listed below.
- Esophagoscopy/Esophagogastroduodenoscopy (EGD)
- Most capsule endoscopies
The program went into effect on January 1, 2020, for Cigna Connect Individual & Family Plan (IFP) customers, except in Florida, and on January 1, 2021, for IFP customers in Florida. On January 1, 2022, this program will begin for most Cigna commercial (non-Medicare) customers who have an outpatient precertification requirement.*
Precertification
For customers included in the January 1, 2022, expansion, eviCore will begin accepting precertification requests on December 13, 2021, for services scheduled on or after January 1, 2022. There will be a two-week grace period for claims with dates of service between January 1, 2022, and January 15, 2022, when Cigna will process claims without precertification.
How to request precertification
The preferred and most efficient method for submitting precertification requests is through eviCore’s website (eviCore.com). While we encourage providers to submit requests through the website, providers may also request precertification by calling eviCore at 866.668.9250 (7:00 a.m. to 7:00 p.m. local time).
It is the responsibility of the provider to obtain precertification. Precertification requests must include the following information:
- Patient’s name, date of birth, and ID from his or her ID card
- Ordering provider’s name, National Provider Identifier (NPI), tax ID, and address
- Rendering facility’s name, NPI, tax ID, and address
- Supporting clinical information
CPT codes
A full list of Current Procedural Terminology (CPT®) codes associated with the affected procedures, as well as additional information about the services, is available at www.evicore.com/resources/healthplan/cigna > Solution Resources > Gastroenterology > CPT CODES > Gastroenterology Code List
Requests
It is the responsibility of the provider to obtain precertification. Precertification requests must include the following information:
- Patient’s name, date of birth, and ID from his or her ID card
- Ordering provider’s name, National Provider Identifier (NPI), tax ID, and address
- Rendering facility’s name, NPI, tax ID, and address
- Supporting clinical information
Precertification is not required for services performed:
- As part of an inpatient stay
- In an emergency room
- During a 23-hour observation
Important notes
- It is the responsibility of the rendering facility and provider to confirm precertification has been requested and approved prior to the service(s) being performed. Verification may be obtained via eviCore.com or by calling 866.668.9250.
- Decisions for non-urgent precertification requests are typically made within two business days of receipt of all necessary clinical information. All decisions are made within five business days.