Overview
Cigna routes most prior authorization requests through EviCore for medical services and through the Cigna provider portal for behavioral health. Standard auth decisions take 15 calendar days. Urgent requests are decided within 72 hours per CMS mandate.
Key Requirements
- Medical services: submit through EviCore at evicore.com or call 1-888-693-3211.
- Behavioral health: submit through the Cigna provider portal or call 1-800-926-2273.
- Required information: patient member ID, provider NPI, diagnosis code (ICD-10), requested procedure code (CPT), clinical notes supporting medical necessity.
- Standard decision timeline: 15 calendar days.
- Urgent/expedited: 72 hours (CMS mandate effective January 2026).
Timeline
Day 1: Submit auth request with complete clinical documentation. Days 2-3: EviCore or Cigna confirms receipt and completeness. Days 4-15: Clinical review and determination. If approved: auth number issued, typically valid 60 days. If denied: written notification with appeal instructions within 2 business days.
Common Denials
| CARC Code | Reason | Primary Cause | Fix |
|---|---|---|---|
| CO-197 | Precertification not obtained | Service performed without auth | Submit PA at least 10 days before service |
| CO-50 | Non-covered service | Service excluded from plan | Verify plan coverage before PA request |
| CO-21 | Required authorization absent | Auth expired or not on file | Confirm auth validity date before service |
Appeals
Appeal denied authorizations within 180 days. Submit a peer-to-peer review request for clinical denials through EviCore within 5 business days of the denial. For formal appeals, submit clinical documentation to the address on the denial letter. Response time: 30 days standard, 72 hours expedited.
FAQ
How do I check Cigna authorization status?
For medical auth: check EviCore's portal at evicore.com using the case reference number. For behavioral health: check the Cigna provider portal under Authorizations. Status updates are available within 24 hours of any change.
Can I request a peer-to-peer review for a Cigna auth denial?
Yes. Request a peer-to-peer through EviCore within 5 business days of the denial. A Cigna medical director will review the case with the requesting provider. This is separate from the formal appeal process.
What if Cigna requests additional clinical information?
Respond within 5 business days. The review clock pauses until Cigna receives the requested documentation. Failure to respond results in a denial for insufficient information.
Prevent These Denials
Altair checks Cigna auth requirements for every procedure before you submit the request.