Cigna for Treatment Centers and Rehab

Cigna

Cigna Healthcare

Cigna is a major national insurer with behavioral health managed through Evernorth, serving commercial, Medicare, and Medicaid members.

Quick Reference

Payer Type

National Commercial

Parent Company

The Cigna Group

Headquarters

Bloomfield, CT

BH Division

Evernorth Behavioral Health

Provider Portal

Open Portal

Portal Guide

View Guide →

Credentialing

CAQH ProView

Timeline

60-90 days

Coverage

1 states

Last Verified

Apr 19, 2026

Published

Mar 15, 2026

Reading Time

12 min

Covered Levels of Care

• Medically Managed Detoxification
• Residential Treatment
• Partial Hospitalization Program (PHP)
• Intensive Outpatient Program (IOP)
• Outpatient Treatment

Medical Necessity Criteria

• ASAM Criteria (for substance use disorders)
• Proprietary Cigna/Evernorth clinical guidelines

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Overview

Cigna Healthcare is one of the largest national health insurers in the United States, providing medical coverage to approximately 18.1 million medical members as of Q3 2025 (per The Cigna Group’s Q3 2025 earnings release) through employer-sponsored, individual, and other commercial plans. Cigna Healthcare operates as a division of The Cigna Group, which also encompasses Evernorth Health Services, the company’s health services arm that manages pharmacy benefits, care delivery, and behavioral health services. Note: In March 2025, Cigna completed the divestiture of its Medicare Advantage, Medicare Part D, Cigna Supplemental Benefits, and CareAllies businesses to Health Care Service Corporation (HCSC), which is reflected in the current medical membership figure.

Behavioral health utilization management, prior authorization, and clinical review functions for Cigna members are handled through Evernorth Behavioral Health. This organizational structure means that treatment centers interact with Evernorth clinical staff for authorization decisions while working with Cigna’s provider network and claims systems for credentialing and reimbursement. Understanding this division of responsibilities is important for navigating the authorization and billing workflows efficiently.

For behavioral health facility operators, Cigna represents a meaningful share of commercial patients in most markets. The company has invested in expanding its behavioral health network in recent years, recognizing increasing demand for substance use disorder and mental health treatment services. Treatment centers that maintain strong relationships with both Cigna’s provider network team and Evernorth’s clinical review staff are better positioned to manage authorizations and reimbursement effectively.

Behavioral Health Coverage

Cigna covers behavioral health services across the full continuum of care, including medically managed detoxification, residential treatment, partial hospitalization programs (PHP), intensive outpatient programs (IOP), and standard outpatient therapy. Coverage details vary by plan design, with employer groups selecting from multiple benefit configurations that may include different cost-sharing structures, day limits, and authorization requirements.

Medical necessity for substance use disorder treatment is evaluated using the ASAM Criteria, supplemented by Cigna’s and Evernorth’s proprietary clinical guidelines. These guidelines outline specific documentation expectations and clinical thresholds for each level of care. For mental health services, Evernorth applies its own clinical criteria that assess symptom severity, functional impairment, risk factors, and the need for a structured treatment environment.

Cigna publishes its coverage policies and clinical guidelines through its provider resources portal. Treatment centers should review the applicable coverage policies for behavioral health services, as these documents detail the specific clinical criteria, documentation requirements, and length-of-stay expectations that Evernorth reviewers use when making authorization decisions. Aligning your clinical documentation with these published criteria is the most effective strategy for obtaining and maintaining authorizations.

Credentialing and Provider Enrollment

Cigna uses CAQH ProView as its primary credentialing data source. To begin the credentialing process, ensure your CAQH ProView application is complete and attested, then submit a network participation request through Cigna’s provider portal or by contacting Cigna’s provider contracting team for your region.

The credentialing process for behavioral health facilities typically takes approximately 60 to 90 days from submission of a complete application, though timelines can vary. Required documentation includes current state facility licenses, individual practitioner licenses for all clinical staff, professional liability insurance certificates meeting Cigna’s minimum coverage requirements, accreditation documentation from CARF or the Joint Commission, DEA registrations for prescribing providers, the facility’s organizational NPI, a completed W-9, and a current program description including staffing ratios and treatment modalities offered.

Cigna may conduct a site visit as part of the facility credentialing process, particularly for residential treatment centers, detoxification programs, and facilities seeking to add new levels of care. Site visits typically evaluate physical plant safety, staffing adequacy, clinical documentation practices, and compliance with applicable state regulations and accreditation standards.

Recredentialing is generally required every 36 months. Ensure your CAQH ProView profile remains current with re-attestation every 120 days. Report any changes to facility ownership, location, licensure, accreditation status, or key clinical staff to Cigna generally within 30 days of the change, though specific notification timelines may vary.

Verification of Benefits (VOB)

Benefits verification for Cigna members can be performed through the Cigna provider portal, by calling the provider services number printed on the member’s insurance card, or electronically through EDI 270/271 eligibility transactions via your clearinghouse.

During a VOB, verify the following: active coverage and effective dates, behavioral health benefit availability for both mental health and substance use disorders, specific levels of care covered under the member’s plan, deductible amounts and year-to-date accumulations, coinsurance or copay amounts by level of care, out-of-pocket maximum and current accumulation, any day or visit limitations, prior authorization requirements, out-of-network benefit availability and terms, and whether any behavioral health functions are managed by Evernorth or another entity.

Cigna plan designs vary widely between employers. Some plans offer comprehensive behavioral health coverage with minimal restrictions, while others may impose day limits on residential treatment, exclude certain levels of care, or apply higher cost-sharing for behavioral health services. Always verify benefits on a per-patient basis.

Document every VOB interaction with the date, time, reference number, and the name of the representative you spoke with. This documentation is essential if disputes arise later about benefit coverage or authorization requirements.

Prior Authorization Requirements

Cigna requires prior authorization for detoxification, residential treatment, partial hospitalization, and intensive outpatient programs. Outpatient services typically do not require prior authorization for in-network providers, though some plan designs may have notification requirements.

Prior authorization requests are reviewed by Evernorth Behavioral Health clinical staff. Submissions should include a comprehensive biopsychosocial assessment, DSM-5 diagnoses, the recommended level of care with clinical rationale, a treatment plan with measurable and time-bound objectives, and documentation addressing all six ASAM dimensions for substance use disorder cases. For mental health authorizations, provide documentation of symptom severity, functional impairment, risk assessment, and the clinical rationale for the requested level of care.

Requests can be submitted through the Cigna provider portal, by calling the Evernorth Behavioral Health authorization line, or through electronic prior authorization platforms. For urgent admissions, notification should generally be provided within 24 to 48 hours, though specific notification windows may vary by plan.

Concurrent review is generally required throughout the course of treatment for authorized levels of care. For residential treatment, concurrent reviews typically occur approximately every 5 to 7 days. PHP reviews are generally conducted every 7 to 14 days, and IOP reviews approximately every 2 to 4 weeks, though intervals can vary. Each concurrent review requires updated progress notes, treatment plan modifications, and documentation of ongoing medical necessity.

When a prior authorization request or concurrent review results in a denial, request a peer-to-peer review as the first step. This allows your treating physician or clinical director to speak with the Evernorth medical director who made the determination. Peer-to-peer reviews must generally be requested within the timeframe specified in the denial notice, typically within approximately 5 to 10 business days, though this timeframe can vary.

Claims and Billing

Cigna accepts electronic claims through clearinghouses in 837I (institutional) and 837P (professional) formats, as well as through the Cigna provider portal. Paper claims are accepted on UB-04 forms for institutional claims and CMS-1500 forms for professional claims, though electronic submission is strongly encouraged for faster processing.

Cigna’s commercial timely filing is generally 90 days from date of service or discharge for participating providers and up to 180 days for non-participating providers, though specific contracts may vary. Medicare Advantage and Medicaid managed care plans may have different timely filing requirements based on CMS or state regulations. Always verify the applicable timely filing deadline for the specific plan type.

Include authorization reference numbers on all claims for services that required prior authorization. Claims submitted without a valid authorization number for services that require it will be denied. Ensure that diagnosis codes, procedure codes, revenue codes, and place-of-service codes are accurate and consistent with the authorized services.

Common denial reasons include missing or invalid authorization, medical necessity not met, timely filing exceeded, coding errors, duplicate claims, and coordination of benefits issues. Cigna’s remittance advice will include specific denial reason codes and instructions for corrective action or appeal.

The appeal process generally includes two levels of internal appeal. First-level appeals must typically be filed within approximately 180 days of the adverse determination, though this timeframe can vary by plan and state. Include all supporting clinical documentation and a detailed explanation of why the denial should be overturned. Second-level appeals are reviewed by a different clinical panel. External review is available after internal appeals are exhausted.

Payer Operations Quick Reference

Mid-task operational data for Cigna billers: phone numbers, payer IDs, filing limits, and addresses — with the entity split that defines Cigna operations: Cigna Healthcare handles the network, claims, and credentialing; Evernorth Behavioral Health handles authorization, concurrent review, and clinical appeals. Phone numbers and payer IDs change; confirm against cignaforhcp.cigna.com ↗ and provider.evernorth.com ↗ before relying on any value here.

Provider phone numbers

Phone-tree shortcuts are intentionally omitted: we only publish IVR navigation verified first-hand with a date.

Payer IDs and EDI

• Primary Cigna payer ID: 62308 for most commercial claims, professional (837P) and institutional (837I).
• Behavioral claims under Evernorth generally still use 62308, but GWH-Cigna legacy plans and some products route to different IDs — match the member card against your clearinghouse list.
• Full plan-by-plan table, ERA/835 enrollment steps, and rejection troubleshooting: see the dedicated Cigna payer ID guide.
• ERA enrollment for 835 remittances runs through your clearinghouse with Cigna; EFT setup via the provider portal.

Timely filing limits

Cross-payer comparison: /denial-code-timely-filing.

Claims and appeals addresses

• Electronic first: 837P/837I via clearinghouse under payer ID 62308; paper is the fallback, and the correct paper address is plan-specific — use the member ID card.
• Appeals: typically two internal levels; first-level appeals generally due within ~180 days of the determination (plan/state variation). Clinical behavioral health appeals are reviewed by Evernorth — request a peer-to-peer with the Evernorth medical director within the window on the denial notice (typically ~5–10 business days). Expedited review (generally within 72 hours) applies to urgent and concurrent-care denials at detox, residential, PHP, and IOP levels.

Credentialing contacts

• Start with CAQH ProView ↗; submit participation via the Cigna provider portal or regional contracting team; recredentialing every 36 months. See insurance credentialing.

Prior-auth quirks for behavioral health levels of care

Operational data last reviewed 2026-06-11; quarterly re-verification cadence applies. See also Evernorth Behavioral Health for the carve-out entity’s own page, and /rcm for how automates Cigna eligibility, auth tracking, and claim routing.

• Detox, residential, PHP, and IOP all require prior authorization through Evernorth, not Cigna — VOB should confirm the Evernorth routing before admission.
• Concurrent review cadence: roughly every 5–7 days for residential, 7–14 days for PHP, 2–4 weeks for IOP; initial residential authorizations typically run 7–14 days.
• Criteria: ASAM Criteria for SUD; Cigna/Evernorth proprietary guidelines for mental health.
• Facility claims at these levels bill 837I/UB-04; include the Evernorth authorization number on every claim or expect an auto-denial.

Frequently Asked Questions

Evernorth is the health services division of The Cigna Group that now manages behavioral health utilization review, prior authorization, and clinical oversight for Cigna members. This transition consolidated behavioral health management functions under the Evernorth brand. For treatment centers, the practical impact is that authorization requests, concurrent reviews, and clinical appeals may be handled by Evernorth Behavioral Health staff rather than Cigna directly. Provider credentialing and claims submission continue through Cigna's existing systems.

Cigna generally requires prior authorization for all residential substance abuse treatment, though specific requirements may vary by plan. Requests are typically evaluated using ASAM Criteria through Evernorth Behavioral Health. You must generally submit a clinical assessment addressing all six ASAM dimensions, a DSM-5 diagnosis, a treatment plan with measurable goals, and documentation demonstrating why a lower level of care would be clinically inappropriate. Initial authorizations are typically granted for approximately 7 to 14 days, with concurrent reviews required for continued stays.

Cigna accepts electronic claims through clearinghouses using 837I (institutional) or 837P (professional) formats. You can also submit claims through the Cigna provider portal. Paper claims are accepted on UB-04 forms for institutional claims and CMS-1500 for professional claims. The standard timely filing limit is generally 90 days from the date of service, though this may vary by plan type. Ensure that authorization numbers are included on all claims for services that required prior authorization.

Cigna generally allows approximately 180 days from the date of the adverse benefit determination to file a first-level appeal, though this timeframe can vary by plan and state. Appeals should be submitted in writing with clinical documentation that specifically addresses the reason for denial. A second-level appeal is typically available if the first level is unsuccessful. After exhausting internal appeals, an external review by an independent organization can generally be requested. Urgent or concurrent care appeals typically receive expedited review, generally within 72 hours.

Cigna credentialing for behavioral health facilities typically takes approximately 60 to 90 days from submission of a complete application through CAQH ProView, though timelines can vary. Required documents generally include state facility licenses, clinical staff credentials, malpractice insurance, accreditation documentation, DEA registrations, and organizational NPI information, though specific requirements may vary. Cigna may request a site visit for residential and detox facilities. Keep your CAQH profile attested every 120 days to prevent delays.

Cigna's main provider services line is 800-882-4462 (1-800-88-CIGNA) for claims, eligibility, and general provider questions on commercial plans. Behavioral health authorization and clinical questions route to Evernorth Behavioral Health at the number on the member's ID card. Confirm current numbers at cignaforhcp.cigna.com before calling, as payer phone numbers change.

Cigna's primary electronic payer ID is 62308 for most commercial claims, professional and institutional. Behavioral health claims managed under Evernorth Behavioral Health generally also use 62308, but certain plans and legacy GWH-Cigna products route differently — verify the ID against the member card and your clearinghouse payer list. See our full Cigna payer ID guide for plan-by-plan detail.

Cigna's commercial timely filing is generally 90 days from the date of service or discharge for participating providers and up to 180 days for non-participating providers, though contracts vary. A claim rejected for a wrong payer ID does not pause the clock — resubmit immediately and keep the original submission report as proof of timely filing.

Key Billing Concepts

Revenue Cycle Resources

This guide is provided for informational purposes only and does not constitute legal, regulatory, or professional advice. Payer requirements, phone numbers, and portal URLs are subject to change. Always verify current information directly with the payer. is not affiliated with the insurance companies described on this page.

• Provider Portal
• Billing Hub
• Code Directory
• RCM Software

Reference tables

Common questions

Official sources

• Open Portalcigna.com
• cignaforhcp.cigna.comcignaforhcp.cigna.com