Change in prior authorization administration for post acute care services, effective January 1, 2026

September 29, 2025

Effective January 1, 2026, HealthSpringSM will manage prior authorizations for Post Acute Care (PAC) services, including Skilled Nursing Facility, Inpatient Rehabilitation, Long Term Acute Care and Home Health. On January 1, Cigna Healthcare® Medicare Advantage becomes HealthSpring.

EviCore by Evernorth® (EviCore) will continue to manage prior authorizations for PAC services through December 31, 2025.

What this means to you and your patients through December 31, 2025:

  • Submit prior authorization requests with dates of service beginning before January 1, 2026, to EviCore as usual. Request prior authorization through our Provider Portal: Providers | Availity.
  • Beginning December 29, 2025, submit initial prior authorization requests to the HealthSpring clinical team for dates of services beginning January 1, 2026. Request prior authorization through our Provider Portal: Providers | Availity.
  • Continue to refer to Availity for the updated prior authorization code lists.
  • There are no changes to the claims submission or appeals processes.

Key changes effective January 1, 2026:

  • Providers will submit initial prior authorization requests directly to the HealthSpring clinical team for inpatient PAC services.
  • PAC facilities will submit concurrent review requests to the HealthSpring clinical team at least two days prior to the current prior authorization end date.
  • Home Health agencies will submit initial prior authorization requests to HealthSpring for home health services. The Home Health agency will submit requests for additional visits past January 1, 2026, to HealthSpring.
  • A list of procedural codes requiring prior authorization will be available at HealthSpring.com/Providers on January 1, 2026.

How to request prior authorization:

Request prior authorization through our Provider Portal: Providers | Availity. Refer to Availity for instructions on setting up an account and navigating the portal.

HealthSpring will continue to use Availity® Essentials as the provider portal. The Cigna Healthcare Medicare Advantage payer space will be renamed HealthSpring Medicare Advantage in January.

We will provide additional information before January 1, 2026, including how to request a prior authorization via phone and/or fax.

Questions?

If you have any questions regarding these changes, please contact your Provider Performance Enablement representative.

Thank you for your partnership and commitment to serving our customers.

Cigna Healthcare® Medicare Advantage is becoming HealthSpringSM.Our new benefit plans will be rolled out under the HealthSpring name during the 2025 annual enrollment period. Starting in January 2026, you will begin seeing patients with HealthSpring benefit coverage. Learn more.

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