November 1, 2024
The Evernorth® Behavioral Administrative Guidelines for participating providers, clinics, and facilities contain our administrative guidelines and program requirements, policies, rules, and procedures pertaining to providing behavioral health services to your patients with Evernorth or Cigna HealthcareSM coverage. The guidelines are part of your provider agreement by reference.1
The Evernorth Behavioral Administrative Guidelines are reviewed semiannually to ensure that the content remains relevant and up to date. The following table is a summary of important changes to the guidelines.
| SECTION | UPDATE |
| Front cover | Updated branding. |
| Changes throughout the guidelines | Minor stye and language changes to comply with updated branding and style guidelines. Changed Cigna to Cigna Healthcare, where appropriate. Removed references to the Cost of Care Estimator. |
| Table of Contents | Minor table changes. |
| Introduction | Significant updates to introductory information. Added Provider Newsroom, Changes and updates, and joining the network sections. |
| Regulatory addenda and state-specific information2 | No changes. |
| Important contact information | Changes to submitting updates to provider directory demographic information. |
| Demographic information and directory | Minor language changes. Updates to the process for submitting changes. Removed Interactive voice response section (moved to Eligibility section). |
| Benefit plan designs and features | Updates to available benefit plans.Added Tiered benefit solutions and profiles. |
| Products | Updates to ID card information, Strategic Alliances, and Evernorth Behavioral Health’s EAP models sections. Added Cigna International Health. Removed International EAP services. |
| Digital solutions | Updates to information about the provider portal. Updates to ePrescribe information. Extensive updates to cultural competency and health equity resources. |
| Onboarding | Removed section, added direction in the Introduction section for providers wishing to join the network to visit the Credentialing page on the provider portal. |
| Credentialing and recredentialing | Minor updates to Credentialing process, Credentialing requirements for facilities, and Recredentialing process sections. |
| Provider specialties and urgent access | Minor language changes. |
| Provider participation | Minor language changes. Expanded nondiscrimination expectations. |
| Eligibility | Minor language changes. Added Interactive voice response section (formerly in Demographic information and directory section). |
| Case management program | Minor changes to Retrospective precertification of inpatient services, Autism spectrum disorder, and applied behavior analysis, Coverage denials, and appeals of coverage denials sections. Added Community Support Program and Caregiver program information. |
| Claims and compensation | Minor language changes. Added claim-related tasks that can be performed via the provider portal. Added Health care accounts and electronic remittance advice sections. Updated claim categories that require supplemental claim information. Updated electronic funds transfer information.Updated Online remittance reports section. |
| Resolving payment questions | No changes. |
| Dispute resolution | Added language addressing appeal requests using automation software or systems. Updated provider termination appeal process information. |
| National ancillaries: Laboratories | No changes. |
| Patient information | No changes. |
| Prescription drug program | Added electronic prior authorization information. Updated expedited prior authorization review process.Updated ePrescribe information. |
| Quality management program | No changes. |
| Resources and forms | No changes. |
| Legal statement | Updated legal statement. |
We also made updates to the following state addenda:
1 For providers in Washington, the medical management program may be communicated in the form of a provider reference manual, in other written materials distributed by Evernorth Behavioral Health, Inc. to providers and/or at a website identified by Evernorth Behavioral Health, Inc.
2 No material changes were made to this page of the Evernorth Behavioral Administrative Guidelines; however, individual state addenda were modified as indicated in the subsequent list.
Please let us know what you think of the Provider Newsroom information and news.
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