Precertifications
Learn how providers can request precertifications for their patients.
Precertification Requirements
Precertification (also known as prior authorization) can confirm the medically necessity of the proposed medical services or medications. It also can help determine if the patient's Cigna Healthcare℠ benefits cover the services or medications.
Precertification requirements will depend on the type of services offered.
How to Request Precertification
Depending on a patient's plan, you may be required to request a precertification for any number of prescriptions or services. We manage the precertification process differently depending on the types of services offered.
Medical Procedures and Services
For many medical procedures, we manage the precertification process directly. There are three ways to do this:
Your Practice Management System or Vendor
The Electronic Data Interchange (EDI) 278 transaction set is called Health Care Services Review Information. A healthcare provider, such as a hospital, will send a 278 transaction to request an authorization from Cigna Healthcare. For EDI 278 Requests and Responses, please contact your EDI vendor or clearinghouse.
Fax
Submit the appropriate precertification intake form to our fax number: 1 (866) 873-8279.
Phone
Call 1 (800) 88CIGNA (882-4462).
For Medical Services you will need:
- Description of service
- Start date of service
- End date of service
- Service code if available (HCPCS/CPT)
The types of services provided for medical procedures can depend on whether Cigna Healthcare collaborates with eviCore or national ancillary vendors to manage the administration of the precertification process.
To see what services are provided and get more information on next steps, visit the precertification resource page on the Cigna for Health Care Professionals (CHCP) website.
Behavioral
For inpatient/partial hospitalization programs, call 1 (800) 926-2273.
You can submit the appropriate form for outpatient care precertifications through the CHCP form center.
Medications and Pharmacy Services
To better serve our providers, business partners, and patients, the Cigna Healthcare Coverage Review Department is transitioning from PromptPA, fax, and phone coverage reviews (also called prior authorizations) to electronic prior authorizations (ePAs).
ePAs save time and help patients receive their medications faster. Moving forward, please use one of the following portals below.
If you are unable to use ePAs, you can call us at 1 (800) 882-4462 to submit a prior authorization request.
Choose a Prior Authorization Portal to Get Started
EviCore® by Evernorth
Conveniently manage your medical and pharmacy drug prior authorization with EviCore by Evernorth.
For both oncology pharmacy drug and medical prior authorization for Cigna Healthcare patients, please choose the option for Medical Oncology Pathways. For other pharmacy drug prior authorization for Cigna Healthcare patients, please choose the option for Pharmacy Drugs (Express Scripts Coverage).
Learn more about EviCore by Evernorth
Surescripts®
Connect to all Pharmacy Benefit Manages (PBMs) and payers with ePA from Surescripts. We can help you easily submit ePA requests and save you valuable time if you haven’t fully integrated ePA into your EHR workflow.
CoverMyMeds®
CoverMyMeds is a one-stop solution that works for all medications and all payers.
