Cigna Healthcare quality resources and more

May 6, 2024

We want you to have the latest information about our quality initiatives, case management programs, and health and wellness programs, as well as medical and pharmacy coverage policies, behavioral clinical practice guidelines, and utilization-management decisions. We hope you find these resources helpful when considering care options for your patients with Cigna Healthcare coverage.

You can find the following resources on the Cigna for Health Care Professionals website (

Quality > Get Questions answered: Resource > Medical Resources >  Commitment to Quality > Quality
Case management/health and > Get Questions answered: Resource > Medical Resources > Case Management/Health and Wellness
Medical and pharmacy coverage > Coverage Policies
Behavioral clinical practice > Get questions answered: Resource > Behavioral Health Resources

Utilization management

We base utilization-management decisions on appropriateness of care and services, standardized evidence-based criteria, and existence of coverage.

We do not reward decision makers for issuing denials of coverage. There are no financial incentives in place for utilization-management decision makers who encourage or influence decision-making.

Your patients have the right to disagree with a coverage decision, and we will provide them with instructions on how to submit an appeal. Your patients can also elect to obtain care at their own expense.

The following services are available to you and your patients, free of charge, when you submit a utilization management request:

  • Language line services
  • Telecommunications device for the deaf (TDD) and teletypewriter (TTY) services. Any deaf, hearing-impaired, or speech-impaired person in the United States can access these services through the 711 dialing code to the Telecommunications Relay Services (TRS), which interfaces with the existing phone equipment used by hearing-impaired persons.

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