Did you know? Less than four percent of all medical services for your patients with Cigna Healthcare Medicare Advantage plans require prior authorization. When services do require it, prior authorization:

• Provides information for you and your patients regarding coverage of services.
• Helps your patients receive disease management, case management, and other available services.
• Helps prevent potential noncovered services and unplanned charges to your patient.
• Facilitates timely payment of claims to you.
• Reduces duplication of services.
• Supports the quality pillar of evidence-based care and guidelines.

Prior authorization requirements are updated quarterly and available online. View current prior authorization guidance at MedicareProviders.Cigna.com > Prior Authorization Requirements.

Part B Step Therapy

Our step therapy program continues to evolve to lower patient drug costs and enhance access to medications. Part B Step Therapy requirements are updated quarterly. To access forms and view 2024 Part B step therapy additions and other requirements, go to MedicareProviders.Cigna.com > Claims, Appeals, Forms and Practice Support > Part B Drugs/Biologics.

To request prior authorization for step therapy through the HSConnect provider portal, go to MedicareProviders.Cigna.com > Login to HSConnect Portal. You can also fax your request to 877.730.3858. For additional assistance, call the Precertification team at 888.454.0013.

Questions?

Visit MedicareProviders.Cigna.com >

• Provider Manual (for pre-service and post-service payment guidance)
• Provider Education > Documentation and Coding Resources > ICD-10 Provider Toolkit (for coding and documentation resources)
• Part B Quick Reference Guide at MedicareProviders.Cigna.com > Forms & Practice Support > Part B Drugs/Biologics > Part B Quick Reference Guide

As a reminder, when referring a patient with a health maintenance organization (HMO) plan to another provider, use the Cigna Healthcare Provider Directory to locate a participating provider. It’s available at Cigna.com > Find a Doctor.