Prior authorization

April 1, 2024

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 > 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 > Claims, Appeals, Forms and Practice Support > Part B Drugs/Biologics.

To request prior authorization for step therapy through the HSConnect provider portal, go to > 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.


Visit >

  • 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 > 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 > Find a Doctor.

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