Cigna Healthcare, now part of The Cigna Group, serves over 18 million members in the U.S. Cigna prior authorization requirements cover advanced imaging, specialty drugs, elective procedures, and outpatient services. Cigna uses eviCore for imaging and other specialty benefit management.
Cigna offers a dedicated provider portal for prior authorization submissions, eligibility checks, and claims management. For imaging authorizations, Cigna routes requests through eviCore. Cigna also supports PA submissions via Availity and phone/fax.
Cigna requires prior authorization for advanced imaging studies, many surgical and outpatient procedures, specialty medications, and certain therapies. They use eviCore (now Evernorth) for imaging and other specialty utilization management. Cigna applies their own coverage policies and evidence-based criteria for PA decisions.
Cigna uses eviCore (Evernorth) for advanced imaging prior authorizations. Providers must submit clinical information through the eviCore portal or phone line. MRI, CT with contrast, PET scans, and nuclear medicine studies typically require PA. Some plans may have additional imaging PA requirements beyond the standard eviCore criteria.
For imaging PAs, submit through eviCore, not the main Cigna portal.
Include complete clinical documentation on the first submission to avoid delays.
Verify whether the member has a Cigna or Cigna-administered plan, as requirements may differ.
Use the Cigna provider portal's PA lookup tool to check requirements before scheduling procedures.
For time-sensitive cases, clearly indicate clinical urgency to qualify for expedited review.
Cigna publishes coverage policies online. Review them before submitting complex PA requests.
Greenlight Medical submits prior authorizations directly to Cigna Healthcare, assembles all required documentation, and tracks status in real time. No portal logins, no phone holds, no fax machines.
See Greenlight in ActionPA requests can be submitted through the Cigna provider portal, Availity, eviCore (for imaging), or by phone/fax. The submission method depends on the type of service. Greenlight Medical automatically routes your PA to the correct submission channel.
Yes, Cigna requires prior authorization for most MRI studies. These are processed through eviCore, which applies evidence-based clinical guidelines. Documentation must support medical necessity for the specific body region and clinical indication.
Standard Cigna PA requests are typically processed within 5-7 business days. Urgent requests can be expedited to 24-72 hours. Electronic submissions through the portal tend to be faster than phone or fax submissions.
eviCore (now part of Evernorth, a Cigna company) is a specialty benefit management company that handles prior authorizations for imaging, cardiology, and other specialty services on behalf of Cigna and other insurers. When you submit an imaging PA for a Cigna member, it routes through eviCore for clinical review.