RADIOLOGY IMAGING


Cigna works with eviCore healthcare (eviCore) to provide high-quality, cost-effective radiology services to Cigna customers in most markets for outpatient, nonemergency, high-tech radiology and diagnostic cardiology care. The following information outlines the highlights of the program.


Delegated services

eviCore is delegated for the following services:

  • Utilization management
  • Appeals

Informed Choice

This program provides:

  • Education about options for geographically convenient and cost-effective facilities for customers undergoing MRI, CT scans, or PET scans.
  • Assistance with scheduling appointments when a new facility has been selected.

Precertification

Precertification helps ensure that individuals receive cost-effective care that is covered under their benefit plans.

For customers with benefit plans that require precertification, eviCore performs precertification for outpatient, nonemergency, high-tech radiology, and diagnostic cardiology services, including:

  • Computed tomography (CT)/computed tomography angiography
  • Magnetic resonance imaging (MRI)/magnetic resonance angiography
  • Positron emission tomography (PET)
  • Nuclear cardiology imaging
  • Stress echocardiogram
  • Diagnostic left and right heart catheterization

How to request precertification

  • Website: eviCore.com
  • Phone: 888.693.3297 (7:00 am–7:00 pm local time)
  • Fax: 888.693.3210

Important notes

  • You can generally determine if a customer’s plan requires precertification for these services by looking for “Outpatient Procedures” on the back of their Cigna ID card.
  • Services requiring precertification should not be scheduled until they have been approved.
  • It is the responsibility of the performing facility to confirm that the referring physician completed the precertification process for advanced imaging procedures.
  • Verification may be obtained through our website at eviCore.com or by calling 888.693.3297.

High-tech radiology precertification is not required for services performed:

  • Inpatient
  • In an emergency room
  • During a 23-hour observation

Site-of-care medical necessity review

High-tech radiology precertification requirements for MRI and CT scans may include a site-of-care medical necessity review when an outpatient hospital setting is requested. There is no change to the process for initiating precertification requests for customers with benefit plans that include a site-of-care medical necessity review. If you request approval for an outpatient hospital setting and do not provide clinical rationale consistent with Clinical Policy criteria, we will deny authorization for the site of service. Medical records may also be required to support the clinical rationale.


Claims (Cigna-contracted providers)

  • Mail: Send claims to the address on the back of the customer’s ID card.
  • Inquiries: Go to CignaforHCP.com.

Claims (eviCore-contracted providers)*

  • Electronically: Use claim ID 62160.
  • Mail: Send to eviCore healthcare, PO Box 981612, El Paso, Texas 79998.
  • Inquiries: Go to eviCore.com.

* These providers must submit claims directly to eviCore. Exceptions include claims where Cigna is secondary to Medicare, or when the claim is for a customer who is part of the Starbridge Beech Street primary network. In these cases, claims should be submitted to Cigna.


Value to providers and customers

  • Through the precertification process, eviCore helps ensure that patients receive tests and treatments that improve diagnoses and follow established coverage guidelines.
  • By reducing duplicative tests and limiting unnecessary radiation exposure, our program improves the quality and safety of care, while facilitating earlier treatment that is more appropriate.
  • eviCore's unique education approach includes the only “predictive intelligence” technology in the industry, which provides nearly instant precertification approval in areas where a physician consistently practices within our evidence-based guidelines.
  • eviCore educates customers about options for cost-effective treatment at certain facilities (through Informed Choice).
  • All Cigna-participating providers in eviCore's network are credentialed and reviewed for quality.

Contact Information


Clinical support through Radiology AnswerLine®

eviCore welcomes requests for clinical discussions from referring providers and radiologists.

  • Phone: 888.693.3211 (option four)

Dedicated program website

eviCore's radiology coverage guidelines

Cigna customer service

  • Phone: 800.88Cigna (882.4462)

eviCore web support:

  • Website: eviCore.com (Upon login, click the “Chat With Us” button located in the upper right-hand corner of the page.)
  • Phone: 800.575.4594 (7:00 am–7:00 pm ET)
  • Email: portal.support@eviCore.com

Customer benefit inquiries and eligibility: