Understanding Cigna Prior Authorization List Requirements

To get started with understanding Cigna's prior authorization list requirements, it's essential to know that Cigna has a comprehensive list of medications and treatments that require prior authorization.

Cigna's prior authorization list is updated regularly, so it's crucial to check the list frequently to ensure you're aware of any changes.

To initiate the prior authorization process, you'll need to submit a request through Cigna's online portal or by contacting their customer service department.

The prior authorization request must include the patient's medical information, the prescribed medication or treatment, and the reason for the request.

To navigate Cigna's prior authorization list, you can log in to CignaforHCP.com and click on Resources > Clinical Reimbursement Policies and Payment Policies > Precertification Policies. This will give you access to the complete list of services that require precertification of coverage.

Some services that require precertification include durable medical equipment, home health and infusion, and gastroenterology. You can also use your practice management system or vendor to submit requests, or contact Cigna directly by fax or phone.

To get started, you can contact Cigna at 1 (800) 88CIGNA (882-4462) or fax 866-873-8279. You can also use EviCore's contact information, which varies depending on the specific service you're requesting: 800.298.4806 for durable medical equipment, 844.457.9810 for gastroenterology, or 866.668.9250 for integrated oncology management.

To access the prior authorization list for Cigna's commercial plans, log in to CignaforHCP.com and click on Resources > Clinical Reimbursement Policies and Payment Policies > Precertification Policies.

You can also use your practice management system or vendor to submit a request through the Health Care Request and Response (ANSI 278) process.

To fax a request, dial 866-873-8279, or call 1 (800) 88CIGNA (882-4462).

The following services require precertification: durable medical equipment, including orthotics and prosthetics, home health and infusion, gastroenterology, and integrated oncology management.

Here are the specific contact numbers and websites for EviCore, which handles some of these services:

Note that these contact numbers and websites are specific to EviCore and may not be applicable to all services that require precertification.

Cigna is making significant changes to its prior authorization list for Medicare Advantage plans. They will remove prior authorization requirements for nearly 500 additional codes later this year.

This change aims to improve health outcomes, make care more affordable, and reduce administrative burdens on the healthcare system.

Cigna has been working closely with clinician partners to make these changes and will continue to hold itself accountable for this important work.

If you're a healthcare provider, you might need to refer a patient to a specialist for further treatment. Cigna requires prior authorization for certain specialist services to ensure they're medically necessary.

Cigna has a list of specialists and services that require prior authorization, which can be found on their website or by contacting their customer service.

The prior authorization process typically takes 2-3 business days, but it may take longer if additional information is needed.

As a healthcare provider, you'll need to submit a referral request to Cigna, including the patient's medical history and the reason for the referral.

Cigna will review the request and make a decision based on their medical policies and guidelines.

To request medication precertification, you'll need some essential information. This includes the customer's insurance and diagnosis details, plus the following specifics about the medication: the name of the drug, its strength (e.g., 5 mg), the quantity being prescribed, and the days' supply.

For example, if you're submitting a request through SureScripts or CoverMyMeds, you can also check the status of a prior authorization through the same ePA service.

To get started, make sure you have the medication's name, strength, quantity, and days' supply on hand. This will help you navigate the precertification process with ease.