Evernorth^® Behavioral Health (Evernorth) is committed to helping health care providers deliver timely care to patients by reducing the administrative burden. Therefore, effective January 1, 2025, we will update the prior authorization requirements for partial hospitalization (PHP) level of care.

Prior authorization will no longer be required for the PHP level of care for your patients with coverage under most Evernorth plans. However, a small number of plans will still require prior authorization.

Please note dates of service prior to January 1 may require prior authorization. Assistance with additional available resources or discharge planning is available by contacting Provider Services at 800.926.2273.

For patients with Cigna Connect IFP plans, services rendered outside of their state of residence could be considered out of network. Therefore, always verify benefits, eligibility and prior authorization requirements prior to rendering services. You can easily identify patients with Cigna Connect IFP plans by viewing their Cigna ID card, which will indicate the plan name.

Network Exception Requests will continue to require prior authorization. A Partial Hospitalization (PHP) Network Exception Request Form is now available on Provider.Evernorth.com (Resources > Forms Center > Behavioral Health Forms).

To verify patient benefits, eligibility and prior authorization requirements

Continue to use the same process that you use today to verify a patient’s benefit plan details and prior authorization requirements before rendering services.

• Call Provider Services at 800.926.2273.
• Log in to the provider portal on Provider.Evernorth.com.
  • Register here to access the portal if you have not already registered. The portal provides 24/7 secure access to patient information such as eligibility and benefits, and allows you to check prior authorization requirements, view remittance reports, enroll in electronic funds transfer (EFT), and make directory profile updates.

 Additional information

If you have any questions, please contact Provider Services at 800.926.2273