August 22, 2025
The Evernorth® (Evernorth) Behavioral Administrative Guidelines for in-network providers, clinics, and facilities include program requirements, policies, rules, and procedures for providing behavioral health services to patients with Evernorth or Cigna Healthcare® coverage. The guidelines are part of your Participating Provider Agreement by reference.1
The Administrative Guidelines are reviewed semiannually to ensure that the content remains relevant and up to date. The following table summarizes important changes to the guidelines:
| Section | Update |
| Regulatory addenda and state-specific information | -Individual state addenda were modified as indicated in the table below. |
| Benefit plan designs and features | -Updated details for Cigna Connect (Individual & Family Plans [IFPs]) -Added Open Access Plus – New Jersey (OAP-NJ) |
| Provider participation | -Clarified appointment access standards language, no timeframes were changed. -Added Risk Adjustment Program to document the process. Please note, this is not a new process. Refer to ACA annual risk-adjustment outreach supports equal access to care for your patients (Provider Newsroom) for additional details. |
| Case Management Program | -Updated link to Appendix F.2 -Updated utilization management/prior authorization for admissions and coverage denials to reinforce the importance of submitting clinical information with requests, and prior to the peer-to-peer and appeal reviews. |
Updates were made to the following state addenda:
| State | Update |
| California | -Minor language changes. -Updated compensation section. -Updated appointment wait time standards. |
| Colorado | -Removed Summary Disclosure Form, Eligibility Verification Mechanisms, Participant ID Cards, Covered Services, Carrier Dispute Resolution Process, Uniform Credentialing Form, Credentialing timing, Preventive Care, and Evernorth Care Designation Appeals Process for Colorado Health Care Professionals sections. |
| Florida | -Added appointment wait time standards. |
| Illinois | -Added appointment wait time standards. |
| Indiana | -Added information on terminations. |
| Massachusetts | -Added information on special services. |
| Michigan | -Added information on requirements of the insurer. |
| New Jersey | -Updated definition of urgent care. |
| Rhode Island | -Added emergent appointment wait time standards. |
| Texas | -Added appointment wait time standards. -Updates to provider termination notice and hearings. |
| Virginia | -Added information for alternative payment methods. |
| Wisconsin | -Added provider responsibilities for terminations. |
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 Appendix F has been updated to remove information found in the Evernorth Behavioral Administrative Guidelines.
Please let us know what you think of the Provider Newsroom information and news.
Contact Us
