As of February 1, 2021, eviCore healthcare (eviCore) will administer the Cigna Sleep Management Program, which consists of two areas – diagnostic sleep studies and positive airway pressure (PAP) therapy support for Cigna commercial customers diagnosed with sleep apnea.
Our goal is to provide high-quality, cost-effective sleep management services to customers who are covered under benefit plans that include precertification of outpatient procedures. The sleep management program does this by helping to ensure that appropriate sleep testing practices are followed and by supporting customers’ use of PAP therapy.
About the program
We are committed to providing providers and their patients with programs and tools that enhance the patient experience, while also improving the quality and affordability of health care. The Sleep Management Program strives to do this by helping to ensure that appropriate sleep testing, treatment, and billing practices are followed.
Precertification of sleep studies and PAP devices
As part of the Cigna Sleep Management Program, all sleep testing services and PAP devices must receive precertification approval from eviCore. Providers can check eligibility and benefits on the Cigna for Health Care Professionals website (CignaforHCP.com).
How to request precertification
- Website: evicore.com/ep360 (follow the instructions for sleep testing and PAP therapy services).
- Telephone: 800.298.4806, press options 1, 1, 1 (8:00 a.m. – 7:00 p.m. local time, Monday – Friday).
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Diagnostic sleep studies
Description
- eviCore reviews all outpatient diagnostic sleep study requests to determine if the service is medically necessary and appropriate based on evidence-based clinical guidelines.
- Codes affected by this review are 95782, 95783, 95800, 95801, 95805, 95806, 95807, 95808, 95810, 95811, G0398, and G0399.
- Cigna manages the network of sleep testing providers for these services.
How to Order
To initiate a sleep study:
- Initiate a service request with a Cigna-participating sleep facility. To find a participating provider, go to Cigna.com > Find a Doctor, Dentist or Facility or call eviCore at 800.298.4806.
- Submit the request for precertification via the eviCore portal (evicore.com/ep360) portal or by calling 800.298.4806, press options 1, 1, 1.
Coverage will be authorized for either a home sleep apnea test or an attended sleep test provided by a Cigna-contracted sleep facility.
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PAP therapy
Description
- When diagnostic sleep study results indicate that a customer requires PAP equipment, the sleep diagnostic or primary care provider should order equipment through a participating durable medical equipment (DME) provider.
- Codes affected by this registration process are E0470, E0471, and E0601.
- eviCore manages the network of DME providers that provide PAP devices and supplies.
How to Order
To request PAP equipment:
- Referring provider initiates a service request with a participating DME provider. To find a participating provider, go to Cigna.com > Find a Doctor, Dentist or Facility or call eviCore at 800.298.4806.
- Submit request for PAP registration via the eviCore portal or by calling 800.298.4806, press options 1, 1, 2. eviCore will then collect customer information and register the PAP therapy device.
eviCore can coordinate PAP education and delivery services.
To enable eviCore PAP therapy monitoring:
- DME providers enter customer information in the online systems of the PAP device manufacturers (e.g., ResMed, Respironics, or Fisher & Paykel).
- Information entered must minimally include customer name, date of birth, health plan name (i.e., Cigna), and health plan identification number.
- Using PAP device usage data, eviCore will support the customer during the first 90 days of therapy by proactively reaching out to the customer’s DME provider and/or referring provider to maximize the adherence to therapy. eviCore will not reach out directly to customers regarding their PAP usage.
For more information about this process, please visit (
eviCore.com/resources/Healthplan/Cigna).
Join the network
- Sleep diagnostic testing network:
- Cigna customer service at 800.88Cigna (800.882.4462).
Submitting claims:
Providers should submit claims electronically or to Cigna at the address on back of the customer’s ID card.
Eligibility and benefits:
Log in to CignaforHCP.com. Then, perform a patient search by name, ID number, or date of birth. Note that you do need to be a registered user of the website to use this tool.
General questions:
Website: Cigna Sleep Management Program website at evicore.com/resources/Healthplan/cigna.
Telephone: Cigna customer service at 800.88Cigna (800.882.4462).