Evernorth Behavioral Health Provider Guide

• EB
• Managed Behavioral Health

Evernorth Behavioral Health

Evernorth Behavioral Health (formerly Cigna Behavioral Health)

Evernorth Behavioral Health is The Cigna Group's BH arm, managing mental health and SUD benefits for Cigna commercial and employer-sponsored plans nationally.

Quick Reference

Payer Type

Managed Behavioral Health

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

60-120 days

Coverage

1 states

Last Verified

Apr 19, 2026

Published

Apr 19, 2026

Reading Time

10 min

Covered Levels of Care

• Medically Managed Detoxification
• Residential Treatment
• Partial Hospitalization Program (PHP)
• Intensive Outpatient Program (IOP)
• Outpatient Treatment
• Medication-Assisted Treatment (MAT)
• Crisis Stabilization

Medical Necessity Criteria

• ASAM Criteria (for substance use disorders)
• Evernorth/Cigna Level of Care Guidelines (proprietary)
• InterQual Behavioral Health Criteria (select services)

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Overview

Evernorth Behavioral Health is the behavioral health management arm of The Cigna Group, administering mental health and substance use disorder benefits for Cigna commercial members and employer-sponsored plans nationally. Previously known as Cigna Behavioral Health, the organization operates under the Evernorth brand following The Cigna Group’s 2021–2022 corporate restructuring, which consolidated Cigna’s health services businesses — including Express Scripts pharmacy benefit management — under the Evernorth subsidiary umbrella.

From a provider’s perspective, the core operational reality is straightforward: Cigna is the health plan and the contracting entity, while Evernorth Behavioral Health is the clinical management subsidiary that handles behavioral health authorization, utilization management, and clinical review on Cigna’s behalf. The member’s insurance card will typically display Cigna, but authorization requests for behavioral health services are routed through Evernorth Behavioral Health’s processes via the Cigna for Healthcare Professionals (CignaforHCP) portal. This structure functions similarly to how UnitedHealthcare routes behavioral health through Optum, or how Elevance routes it through Carelon — the MBHO carve-out model, applied within a corporate family rather than as an independent company.

The Cigna Group is one of the largest health services companies in the United States, with Cigna commercial plans covering tens of millions of members across employer-sponsored, individual, and government-sponsored programs. Evernorth Behavioral Health’s national footprint means that for most behavioral health treatment centers, Cigna/Evernorth is among the top commercial payers by volume. Understanding the two-brand structure — Cigna for the health plan and Evernorth for behavioral health management — is essential for navigating authorizations and claims correctly.

Behavioral Health Coverage

Evernorth Behavioral Health administers coverage for the full continuum of behavioral health services for Cigna commercial members, including medically managed detoxification, residential treatment, partial hospitalization programs (PHP), intensive outpatient programs (IOP), standard outpatient treatment, crisis stabilization, and medication-assisted treatment (MAT). Coverage specifics depend on the individual member’s plan design — employer-sponsored fully insured plans, self-funded employer plans, and individual marketplace plans all have different benefit structures, and self-funded plans are governed by the employer’s specific plan document rather than standard Cigna benefit designs.

For medical necessity determinations, Evernorth Behavioral Health uses the ASAM Criteria as the primary framework for substance use disorder level-of-care decisions. For mental health services, Cigna’s Level of Care Guidelines (proprietary criteria) define the symptom severity, functional impairment, risk factors, and treatment intensity requirements at each level of care. For certain medical-behavioral health services, InterQual criteria may be applied. These guidelines are available to providers through the CignaforHCP portal under clinical resources.

Cigna’s behavioral health benefit design for employer-sponsored plans includes federal mental health parity compliance, meaning that non-quantitative treatment limitations applied to mental health and substance use disorder services must be comparable to those applied to medical and surgical benefits. Treatment centers that encounter inconsistent authorization standards — for example, where Cigna requires more frequent concurrent reviews for SUD residential treatment than for comparable medical admissions — have parity complaint rights under federal law and, in many states, additional state parity enforcement options.

Coverage across Cigna’s different plan types varies in important ways. Fully insured commercial plans follow Cigna’s standard benefit designs. Self-funded employer plans are governed by the employer’s plan document, which may impose benefit limitations or exclusions that Cigna’s standard commercial plans do not. Government programs such as Cigna’s Medicare Advantage plans follow CMS coverage frameworks. Always verify the specific plan type and applicable coverage rules before rendering services.

Credentialing and Provider Enrollment

Cigna uses CAQH ProView as the foundation of its behavioral health credentialing process through Evernorth. Before initiating provider enrollment, ensure your CAQH ProView profile is complete, fully attested, and up to date. Behavioral health facility enrollment can be initiated through the CignaforHCP portal at cignaforhcp.cigna.com ↗ or by contacting Cigna provider relations.

The credentialing timeline for Cigna behavioral health typically runs approximately 60 to 120 days from submission of a complete application. Timelines can vary based on application completeness, network adequacy assessments, and volume. Commonly required documents include: current state behavioral health facility licenses for each service type, Joint Commission or CARF accreditation, professional liability insurance with adequate limits, organizational NPI and taxonomy codes, federal tax ID and W-9, a program description with clinical services and staffing, and DEA registrations for prescribing clinicians.

For substance use disorder treatment programs, Cigna may require state-specific certifications such as OASAS certification in New York or DHCS certification in California in addition to standard accreditation. Verify applicable state requirements with Cigna provider enrollment before submitting your application.

Cigna may conduct site visits for residential treatment centers, detoxification programs, and other facility-based programs as part of the credentialing process. Be prepared to demonstrate compliance with state licensing standards, your accreditation organization’s standards, and Cigna’s facility requirements. Recredentialing generally occurs every 36 months. Maintain CAQH ProView attestation every 120 days and notify Cigna promptly of material changes to your facility, licensure, or clinical leadership.

Individual clinical staff credentials are managed separately at the clinician level within the facility contract. Confirm with Cigna whether facility credentialing covers all staff under a facility agreement or whether individual clinician credentialing is also required for your specific contract type.

Verification of Benefits (VOB)

Benefits verification for Cigna members with Evernorth-administered behavioral health can be performed through the CignaforHCP portal at cignaforhcp.cigna.com ↗, by calling the Cigna provider services number on the member’s insurance card, or through EDI 270/271 electronic eligibility transactions via your clearinghouse.

When verifying benefits, confirm the following: active Cigna coverage status and effective dates; the specific plan type (fully insured employer, self-funded employer, individual, Medicare Advantage); behavioral health benefit availability, confirming that behavioral health is administered through Cigna/Evernorth rather than a separate carve-out; covered levels of care for both mental health and substance use disorders; deductible amounts and year-to-date accumulations; coinsurance or copay requirements for each level of care; out-of-pocket maximum and current status; any day, visit, or dollar limitations; authorization requirements by level of care; and out-of-network benefit availability if applicable.

For self-funded employer plans, the benefit structure is set by the employer and may differ substantially from standard Cigna commercial benefits. Cigna processes claims and manages authorizations for these plans on an administrative services only (ASO) basis, but coverage rules are governed by the employer’s Summary Plan Description. When verifying benefits for a self-funded member, note that benefits may be more or less restrictive than standard Cigna commercial plans, and appeals for self-funded plans are ultimately governed by ERISA rather than state insurance law.

Document all VOB details thoroughly: verification date, method, representative name, reference number, confirmed eligibility, applicable cost-sharing, covered levels of care, and authorization requirements. Benefits verification does not guarantee payment — authorization, medical necessity, and proper claims submission are still required.

Prior Authorization Requirements

Evernorth Behavioral Health requires prior authorization for residential treatment, medically managed detoxification, and partial hospitalization programs across most Cigna commercial plans. Authorization requirements for intensive outpatient services vary by plan, with many commercial plans requiring authorization for IOP. Standard outpatient services generally do not require prior authorization for in-network providers, though some plan designs may have notification requirements.

Prior authorization requests are submitted through the CignaforHCP portal, by phone, or by fax using the contact information on the member’s insurance card. For electronic submission, the CignaforHCP portal supports real-time and batch authorization requests. Documentation should include a comprehensive clinical assessment, DSM-5 diagnoses, the recommended level of care with level-of-care documentation for substance use disorders or Cigna’s Level of Care Guidelines for mental health, a treatment plan with measurable goals, substance use and psychiatric history, previous treatment episodes, medications, and risk assessment.

Concurrent reviews are required for all residential and inpatient stays. Cigna’s standard intervals are approximately 5 to 7 days for residential treatment, 7 to 14 days for PHP, and 2 to 4 weeks for IOP, though intervals can vary by plan and clinical circumstances. Each concurrent review requires updated clinical documentation demonstrating ongoing medical necessity, treatment progress, and active discharge planning including targeted step-down dates.

If a prior authorization request is denied, you have the right to request a peer-to-peer review with a Cigna/Evernorth medical director. Request the peer-to-peer promptly — most payers allow only a limited window (often 2 to 3 business days) for peer-to-peer requests after a denial. Document all peer-to-peer conversations including the date, participants, clinical rationale presented, and outcome.

Claims and Billing

Claims for Cigna commercial members with Evernorth-administered behavioral health are submitted to Cigna, not to a separate Evernorth entity, using the Cigna behavioral health payer ID. Electronic claims are submitted in 837I (institutional) or 837P (professional) format through your clearinghouse or directly through the CignaforHCP portal. Paper claims use the UB-04 for institutional and CMS-1500 for professional.

Cigna operates multiple payer IDs, including separate IDs for behavioral health versus medical, and different IDs for specific product lines (commercial, Medicare Advantage, government). Confirm the correct Cigna behavioral health payer ID with your clearinghouse before submitting claims. Using an incorrect payer ID is a common source of claims routing errors and rejections.

The standard timely filing window for Cigna commercial plans is generally 90 days from the date of service for participating (in-network) providers, though your specific provider agreement may specify a different timeframe. For self-funded employer plans, the timely filing requirement is set by the employer’s plan document and may differ. Medicare Advantage plans follow the one-year CMS timely filing rule for non-contracted providers. Always verify the applicable timely filing deadline for each plan type before submitting.

Common denial reasons include lack of prior authorization, medical necessity not established or documentation insufficient, timely filing exceeded, incorrect payer ID, coordination of benefits issues, services rendered by non-credentialed providers, and self-funded plan benefit exclusions. Cigna’s appeal process for commercial plans includes two levels of internal appeal. First-level appeals should generally be filed within 180 days of the adverse benefit determination, though timeframes vary by plan. After internal appeals are exhausted, external review through an independent review organization is available as required by state and federal law.

Key Contact Information

Related payer: Cigna — Full Provider Guide

• Provider Portal: CignaforHCP ↗ (cignaforhcp.cigna.com) — Cigna’s primary provider transaction platform for eligibility, authorization, and claims; handles Evernorth Behavioral Health transactions
• Credentialing: CAQH ProView ( proview.caqh.org ↗ ) for data; initiate enrollment through the CignaforHCP portal or contact Cigna provider relations
• Prior Authorization: Submit through CignaforHCP or by phone/fax using the number on the member’s insurance card
• Verification of Benefits: CignaforHCP portal for electronic verification; Cigna provider services for phone verification
• Claims Submission: Electronic 837 via clearinghouse using the Cigna behavioral health payer ID — confirm correct payer ID with your clearinghouse; do not use Cigna medical payer IDs for behavioral health claims
• Claims Mailing Address: Varies by plan type; refer to the member’s insurance card or CignaforHCP for the correct address
• Corporate Parent: The Cigna Group (evernorth.com)
• Clinical Guidelines: Available through CignaforHCP under provider resources

Frequently Asked Questions

Cigna is the commercial health insurance brand — it issues health plan IDs, processes medical claims, and covers most physical health benefits. Evernorth is The Cigna Group's health services subsidiary, created in 2021 as the corporate parent of businesses including Express Scripts (pharmacy benefit management), Evernorth Behavioral Health, and other health services. Evernorth Behavioral Health is the entity that actually manages behavioral health benefits for Cigna commercial members, handling utilization management, prior authorization, and clinical review. From a provider's operational standpoint, Cigna is usually the payer name on the member's card and the entity you contract with, while Evernorth Behavioral Health is the clinical management entity you interact with for behavioral health authorization. Submit claims to Cigna using the Cigna payer ID, but route behavioral health authorization requests through the Cigna for Healthcare Professionals portal, which handles Evernorth-administered BH authorizations.

Prior authorization for behavioral health services for Cigna members — including those whose benefits are administered by Evernorth Behavioral Health — is generally submitted through the [Cigna for Healthcare Professionals portal](https://cignaforhcp.cigna.com) (CignaforHCP). This portal handles both medical and behavioral health authorizations. You can also submit authorization requests by phone or fax using the number on the member's insurance card. For behavioral health services, your request should include a comprehensive clinical assessment, DSM-5 diagnoses, the recommended level of care with level-of-care documentation for SUD, a treatment plan with measurable goals, prior treatment history, and risk assessment. Cigna uses its own Level of Care Guidelines for medical necessity review of both mental health and substance use disorder services.

For Cigna commercial plans, the standard timely filing window for participating providers is generally 90 days from the date of service, though your specific provider agreement may specify a different timeframe. For non-participating (out-of-network) providers, the filing window may differ. Self-funded employer plans administered by Cigna may have different timely filing requirements specified in the employer's plan document. Always refer to your specific Cigna provider agreement and the member's Summary Plan Description (for self-funded plans) for the applicable deadline. Claims submitted after the timely filing deadline are typically denied without appeal rights. Verify current requirements for each specific plan through the [Cigna provider portal](https://cignaforhcp.cigna.com).

Yes. Behavioral health authorizations and transactions for Cigna members — including services administered through Evernorth Behavioral Health — are handled through the [Cigna for Healthcare Professionals portal](https://cignaforhcp.cigna.com). There is not a separate Evernorth-branded provider portal distinct from CignaforHCP for routine behavioral health transactions. Evernorth is The Cigna Group's operational subsidiary for health services, but the provider-facing interface remains the Cigna portal for most provider workflows. Some Evernorth business lines that serve non-Cigna health plans may have different portal arrangements — if Evernorth manages behavioral health for a non-Cigna plan, confirm the portal and submission route with that plan's provider services team.

The Cigna Group's 2021–2022 corporate restructuring — which organized Cigna's health services businesses under the Evernorth brand — was a corporate reorganization rather than a new company formation. Behavioral health functions that were previously branded 'Cigna Behavioral Health' were administratively transitioned to Evernorth Behavioral Health, but provider contracts generally remained in place with Cigna as the contracting entity. Your Cigna behavioral health provider agreement and network participation should have continued through the restructuring. However, if you have questions about your specific contract terms, or if you notice any discrepancy in how claims or authorizations are being processed, contact [Cigna provider services](https://cignaforhcp.cigna.com) for clarification. The operational change most relevant to providers is the Evernorth brand name now appearing in some communications and clinical review documents.

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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.

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