As of February 1, 2021, eviCore healthcare^® (eviCore) manages home health care, durable medical equipment (DME), and home infusion therapy for Cigna commercial customers. eviCore has a national network of providers who offer these services.

On January 1, 2023, eviCore began managing the provider network for orthotics and prosthetics (O&P) services for Cigna commercial customers.

O&P service administration

eviCore is responsible for the following:

• Provider contracting, credentialing, and demographic updates
• Claims processing for Shared Administration Repricing and Payer Solutions customers
• Initial precertification requests (forwards precertification request/information over to Cigna)
• Customer care coordination efforts

Cigna is responsible for the following:

• Claims processing, except for Shared Administration Repricing and Payer Solutions customers
• Customer-based services, including benefits, eligibility, and appeals
• Utilization review and precertification
• Provider and customer denial letters for services that are not authorized

eviCore-provided services

The following table provides examples of eviCore-provided services.

SERVICES	EXAMPLES
DME	Beds, wheelchairs, walkers, scooters, off-the-shelf DME (e.g., braces, splints, slings), and compression (tight-fitting) clothing for all body areas to help post-surgery healing and improve circulation
O&P	Prefabricated and fabricated (custom) O&P, postmastectomy supplies (i.e., bras, forms, and compression sleeves), and wigs
Respiratory equipment	Oxygen, continuous positive airway pressure equipment, and ventilators
Enteral nutrition	Pumps and enteral nutritional support
Home infusion therapy	Anti-infective therapy, total parenteral nutrition, pain management, inotropic therapies, immune globulin, enzyme replacement, and REMICADE®
Home health care	Nursing, therapies, social work, and home health aides
Other specialty services	Insulin pumps and supplies, continuous passive motion machines and supplies, wound vacuums and supplies, and breast pumps

Service coordination through eviCore

To order eviCore-provided services for your patients with Cigna-administered coverage, contact a participating provider. To find a participating provider, call eviCore at 800.298.4806 or go to Cigna.com > Find a Doctor.

 

You may request precertification through eviCore in the following ways:

• Telephone - Call 800.298.4806 and select options 3, 1, and 1.
• Fax - Send to 888.444.1027.
• Web portal - Go to www.evicore.com/ep360.

For additional information, refer to eviCore’s provider resources website (www.eviCore.com/resources/healthplan/Cigna). The website includes several educational materials: frequently asked questions documents, quick reference guides, provider training presentations, DME and O&P precertification form, and lists of Healthcare Common Procedure Coding System codes that require precertification through Cigna.

 

Other services/supplies provided in the home through national providers

The services and national providers are outlined below: