Musculoskeletal and Spine Surgery Management Program
About the program
Cigna HealthcareSM works with EviCore by Evernorth® to administer a precertification program for Cigna Healthcare customers for certain musculoskeletal services (e.g., interventional pain management and major joint surgery procedures for the hip, knee, and shoulder) and spine surgeries for outpatient and inpatient services.
Delegated services
EviCore is delegated for the following services:
- Utilization management, including precertification
- Clinical appeals
Precertification
Our precertification program helps ensure that individuals receive coverage for cost-effective care that is based on established evidence-based guidelines.
Precertification is required for:
- All Cigna Healthcare customers receiving these services in an inpatient setting.
- Cigna Healthcare customers receiving these services in the outpatient setting and whose ID card identifies that precertification is required for outpatient procedures.
For a full list of Current Procedural Terminology (CPT®) codes included in this program (and that require precertification to be requested through EviCore), please go to evicore.com/Cigna
How to request precertification
Providers can request precertification in of three dedicated ways:
- Portal: eviCore.com
- Telephone: 866.668.9250 (8:00 a.m. - 9:00 p.m. ET)
- Fax: Find online fax forms at Provider's Hub | EviCore by Evernorth > Provider Resources > Fax Forms and Clinical Worksheets
- To request precertification for urgent requests, providers must call EviCore at 888.693.3297.
Contact Information
Clinical support
EviCore welcomes requests for clinical discussion from rendering providers. To request a clinical discussion, call EviCore at 888.693.3297, select option four.
Submitting claims
All providers should submit claims directly to Cigna Healthcare at the address on the back of the patient's ID card.
Submitting clinical appeals
Providers should refer to the denial notification for instructions on where to submit appeals.
Dedicated portal support
Contact the eviCore support team by:
- Telephone: 800.575.4594 (8:00 a.m. - 9:00 p.m. ET)
- Email: portal.support@evicore.com
- Online: Click on "Online Chat" located in the upper right-hand corner of each page at EviCore.com.
Medical coverage guidelines
Coverage guidelines are available at EviCore Cigna Commercial Membership | EviCore by Evernorth