We would like to share the following important administrative reminders with behavioral health providers caring for Evernorth^® Behavioral Health and/or Cigna Healthcare customers. 

+ Administrative guidelines 

Evernorth understands that a stable provider network facilitates consistent and superior customer service. For that reason, we seek to build strong, long-standing relationships with our participating providers.

The Evernorth Behavioral Administrative Guidelines are part of your contract and provide important information about a variety of topics, including the referral process, case management services, and claims. They are updated at least bi-annually and contain the most up-to-date information on how we can most effectively work together.

+ Open dialogue and medically appropriate care

Evernorth encourages open discussion about appropriate care and treatment options, regardless of benefit coverage, among health care providers, health care facilities, and the individuals we serve.

Evernorth advocates for medically appropriate care. This goal is central to our evidence-based care philosophy, and we consider the quality and appropriateness of care and services in all decision-making. Evernorth requires all Evernorth employees and consultants who make behavioral health utilization management decisions to annually complete an attestation affirming that:

+ Utilization management decision-making is based only on the appropriateness of care and service and active coverage.

+ Professionals and other individuals making utilization management decisions are not specifically rewarded for issuing denials of coverage or services.

+ Financial incentives for utilization management decision-makers do not encourage decisions that result in underutilization.

You can call the number on the back of your patient’s ID card to request services or a consultation with an Evernorth Behavioral Health medical director.

+ Treatment records

Evernorth conducts an annual review of behavioral health care provider treatment records in states where it is required. With executed consent, we review records for evidence of coordination of care between primary and behavioral health care providers.

Treatment records should:

+ Include the patient’s name and identification number on each page.

+ Be easily and readily retrievable in a secure environment that protects customer confidentiality.

+ Include documentation for all individuals to whom you provide services. 

In addition, each entry in the treatment record should be legible, signed with the provider’s name and credentials, dated, and maintained in a consistent chronological order. For a complete listing of essential items to include in your treatment records, visit the Treatment record-keeping section of the Behavioral Administrative Guidelines.

+ Quality of care

Evernorth gathers quality of care information from customers who receive services from our network of behavioral health care providers. We conduct a quarterly evaluation of rates for quality-of-care complaints and analyze the nature of those complaints. Based on our assessments and analysis, we provide feedback to behavioral health care providers and staff, where appropriate. 

As a behavioral health care provider who shares our mission to help people, you are essential to ensuring that their care experience meets our high standards for quality and service.

We appreciate your commitment to care and safety.