August 15, 2024

In keeping with its commitment to harnessing the power of technology and data, Evernorth^® Behavioral Health has made the following enhancements to the provider portal (Provider.evernorth.com):

• Submit appeals of precertification decisions (preservice): Registered users with access to patient search and precertification website entitlements can submit and check the status of appeals of precertification decisions.*
• Digital claim and precertification correspondence via the new Message Center: The Message Center feature in the provider portal allows registered users with claim and/or precertification entitlement(s) to receive notifications for claims and precertification requests that have been processed, pended, or denied.* The Message Center can automatically provide daily or weekly status updates via email. Users can turn off notifications by adjusting their preferences.

Highlights for registered users:

• Effective May 23, 2024: Received access to portal settings and preferences to set their notifications.
• Effective June 20, 2024: Users with the claim search entitlement received access to digital claim correspondence notifying them that new claim letters are available, or action is required to continue processing.
• Effective July 18, 2024: Users with the precertification entitlement received access to digital precertification correspondence notifying them that new precertification letters were available, or action was required to continue processing.
• Note: Website access managers can choose to continue receiving paper claim and/or precertification-related letters for their practice by updating the correspondence delivery under the settings and preferences section in the portal.
• Provider TINs that are not registered for the portal will continue to receive paper claim- and precertification-related letters.

* Website access managers can assign entitlements to users in their practice based on their roles. To gain access to website entitlements, please contact your practice’s website access manager. 

** You may continue to receive some paper letters for claim and/or precertification correspondence. Currently, digital correspondence only applies to certain PPO plans.

Questions and answers

Appeals of precertification decisions

1. Who can appeal a precertification decision?
   Registered users of the provider portal (Provider.Evernorth.com) who have been granted access by their website access manager to the patient search and precertification website entitlements can submit an appeal of a precertification decision.
2. How is an appeal of a precertification decision submitted?
   Please refer to our Precertification Decision Appeals Online Quick Reference Guide for detailed information.
3. Who can view if a precertification has been appealed?
   Users with patient search and precertification entitlements can view if a precertification has been appealed.
4. Can an appeal be started by one user and completed by a different user?
   Yes. If a user starts an appeal but is unable to complete it, they can save a draft, which will be available for five calendar days. Within that five-day period, any user with the precertification entitlement can open the request, complete it, and submit it.  If the draft is not submitted within five calendar days, it will be deleted and the user will need to begin a new request.
5. What does “open draft” mean?
   It means that the appeal has been started and saved but has not yet been submitted.
6. What level of access is needed to review the details of an open draft?
   Only users with the precertification entitlement can view the details of an open draft for a precertification appeal.
7. Can an appeal request be deleted?
   No. Once an appeal request has been submitted, it cannot be changed or deleted.
8. Can a request for an escalation be submitted online?
   No. A request cannot be escalated online.
9. Is there a limit to the number of online appeal requests that can be submitted?
   Yes. Up to five precertification appeals can be submitted per request. However, each request must be completed before another can be started.
10. What is the turnaround time for an online appeal request?
    A written response will be sent within 30 days of receipt of the appeal. Note: Time periods are subject to, and may be extended by, applicable law or provisions within the provider agreement.
11. Are appeal determination letters available online?
    No. Appeal decision letters are not available online at this time. These letters will continue to be mailed.

Message Center: digital claim and precertification correspondence

• When did Evernorth execute its transition to digital correspondence?
  • On June 20, 2024, we transitioned all registered users with the claim entitlement to digital correspondence.
  • On July 18, 2024, we transitioned all registered users with the precertification entitlement to digital correspondence.
• Can providers still get paper letters for claim- and/or precertification-related correspondence?
  • Yes. Website access managers can choose to continue receiving paper claim- and/or precertification-related letters by adjusting their settings and preferences.
• What will digital correspondence look like?
  • When users enter the existing Message Center in the provider portal, new correspondence is sorted from newest to oldest. This page will function like an email inbox, where users can easily filter for communications that are of most interest to them. They can also click the “review” button to view and print the letter. The green dots indicate that a message has not been opened. (See screenshot below.)*

*Appearance of Message Center is subject to change

• How do users know when digital correspondence is available?
  • Users can personalize their notification preferences and choose to receive them via email and/or the Message Center. Note: Provider TINs that are not registered for the provider portal will continue to receive paper letters.
• Who has access to digital correspondence?
  • Users with claim search and precertification entitlements will have access to the respective digital correspondence. Website access managers can assign these entitlements to users in their practice based on their roles.
• How do users know which entitlements they have?
  • Users can view your entitlements/access rights by navigating to Settings & Preferences > Online Access > View Access, then select their TIN. A list of access rights for their TIN will display.
• Can users set their own preferences?
  • Yes. Users can navigate to Settings & Preferences>Message Center Notifications to edit their notification preferences and correspondence delivery (see screenshot below). Users can select the category and type of messages they would like to see in the Message Center. They can also choose to receive email notifications when messages are available.
    • Only website access managers have access to “Correspondence Delivery”, where they can turn paper delivery on or off.

• For more information, including how to access the Message Center and change your notification settings and preferences, please see the Provider.Evernorth.com Message Center Quick Reference Guide.

• How is digital correspondence organized?
  • Most correspondence related to claims and precertification is delivered to the Message Center inbox based on a user’s settings and preferences. Correspondence will have both a category and type. Users can flag messages, which will appear in the Flagged tab. They can also archive messages, which will appear in the Archive tab. Deleting a message will permanently delete it from the Message Center.
  • Correspondence specific to a claim or precertification can also be found on the Claim Details or Precertification Details screen in the New Correspondence History tab. It will always be viewable in this location, even if a website access manager deletes it from their Message Center.
• How long will digital correspondence be available?
  • Digital correspondence will be available online for a rolling two-year period. Users can also save any letter to their computer and print it.
    • Note: Paper letters sent to prior to the launch of digital correspondence will not be available in a digital format.
• Can users choose how often they receive digital notifications?
  • Yes. Users can choose if they want to receive email notifications and at what frequency (e.g., daily, weekly, or off).
  • Note: Preferences are unique to the user, not the TIN. Users can also set different preferences for different TINs.
• What types of email notifications will be available?
  • Users can receive up to four different email notifications. Subject lines include: 
    • Claim correspondence now available.
    • Action required: Cigna Healthcare^SM claim(s).
    • Precertification correspondence now available.
    • Action required: Supporting documentation for precertification(s).
• If a new TIN registers with an established website access manager, do they have the option to receive paper letters?
  • When a new TIN registers and a website access manager is established, the correspondence delivery settings will default to: “Paper and online delivery”. 
• Can users opt out of digital correspondence?
  • No. Digital correspondence will always be available. However, website access managers can select to continue receiving claim and/or precertification-related paper letters via “Settings and Preferences” on CignaforHCP.com.

Additional information

For additional information, please refer to our Precertification Decision Appeals Online Quick Reference Guide  and Provider.Evernorth.com Message Center Quick Reference Guide. For further assistance, please call Provider Services at 800.926.2273.