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id="1564901609416"><div class="expand-collapse"> <p> <a class="expandall">Expand All</a> / <a class="collapseall">Collapse All</a> </p> <div id="accordion-light-4686" class="accordion accordion-light accordion-blue"> <div data-ct-component="Accordion" class="accordion-panel panel"> <h5 class="accordion-panel-heading" role="tab" id="annual-enrollment-period--aep-provider-resources-tool-kit-4686"> <a data-target="#annual-enrollment-period--aep-provider-resources-tool-kit-panel-4686" aria-expanded="true" data-toggle="collapse" role="button" class="collapsed"> <svg class="arrow" aria-hidden="true"> <use xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="/static/svgs/legacy/component-sprite.svg#el-caret-right"></use> </svg> <svg class="arrow-expanded" aria-hidden="true"> <use xlink:href="/static/svgs/legacy/component-sprite.svg#el-caret-down"></use> </svg> Annual Enrollment Period (AEP) Provider Resources Tool Kit</a> </h5> <div 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href="/static/medicareproviders-cigna-com/docs/outpatient-request-form-behavioral-health.pdf" target="_blank" rel="noopener">Outpatient Treatment Request Form [PDF]</a></li> </ul></div> </div> </div> <div data-ct-component="Accordion" class="accordion-panel panel"> <h5 class="accordion-panel-heading" role="tab" id="claims-4686"> <a data-target="#claims-panel-4686" aria-expanded="true" data-toggle="collapse" role="button" class="collapsed"> <svg class="arrow" aria-hidden="true"> <use xlink:href="/static/svgs/legacy/component-sprite.svg#el-caret-right"></use> </svg> <svg class="arrow-expanded" aria-hidden="true"> <use xlink:href="/static/svgs/legacy/component-sprite.svg#el-caret-down"></use> </svg> Claims</a> </h5> <div aria-labelledby="claims-4686" role="tabpanel" id="claims-panel-4686" class="collapse"> <div class="accordion-panel-body"><ul class="link-lists list-no-indent" data-ct-header="English|Claims"> <li><a title="2022 Cigna Medicare Advantage Provider Manual" 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Information </a></li> <li><a title="Cigna Guide to Your Explanation of Payment (EOP)" href="/static/medicareproviders-cigna-com/docs/how-to-read-explanation-of-payment.pdf" target="_blank" rel="noopener">How to Read an Explanation of Payment (EOP) [PDF]</a></li> <li><a title="Cigna HSConnect Online Portal for Medicare Advantage Providers" href="https://www.hsconnectonline.com/login" target="_blank" rel="noopener">Provider Online Portal – HSConnect</a></li> <li><a href="https://cignaforhcp.cigna.com/app/login" target="_blank" title="Cigna for Health Care Professionals Portal Login" rel="noopener">Provider Online Portal – CignaforHCP</a> <span style="color: #e35205;">(AZ Only)</span></li> </ul></div> </div> </div> <div data-ct-component="Accordion" class="accordion-panel panel"> <h5 class="accordion-panel-heading" role="tab" id="network-interest-forms---facility-ancillary-4686"> <a data-target="#network-interest-forms---facility-ancillary-panel-4686" aria-expanded="true" data-toggle="collapse" role="button" class="collapsed"> <svg class="arrow" aria-hidden="true"> <use xlink:href="/static/svgs/legacy/component-sprite.svg#el-caret-right"></use> </svg> <svg class="arrow-expanded" aria-hidden="true"> <use xlink:href="/static/svgs/legacy/component-sprite.svg#el-caret-down"></use> </svg> Network Interest Forms - Facility/Ancillary</a> </h5> <div aria-labelledby="network-interest-forms---facility-ancillary-4686" role="tabpanel" id="network-interest-forms---facility-ancillary-panel-4686" class="collapse"> <div class="accordion-panel-body"><ul class="link-lists list-no-indent" data-ct-header="English|Network Interest Forms - Facility/Ancillary"> <li><a title="Cigna Medicare Advantage Facility/Ancillary Network Interest Forms for Alabama, North Florida, and Southern Mississippi" href="/static/medicareproviders-cigna-com/docs/facility-network-interest-form-al-nfl-sms.pdf" target="_blank" rel="noopener">Alabama, North Florida, and Southern Mississippi 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Interest Forms for Georgia" href="/static/medicareproviders-cigna-com/docs/facility-network-interest-form-ga.pdf" target="_blank" rel="noopener">Georgia [PDF]</a></li> <li><a title="Cigna Medicare Advantage Facility/Ancillary Network Interest Forms for Illinois" href="/static/medicareproviders-cigna-com/docs/facility-network-interest-form-il.pdf" target="_blank" rel="noopener">Illinois [PDF]</a></li> <li><a title="Cigna Medicare Advantage Facility/Ancillary Network Interest Forms for Kansas City" href="/static/medicareproviders-cigna-com/docs/facility-network-interest-form-kc.pdf" target="_blank" rel="noopener">Kansas City [PDF]</a></li> <li><a title="Cigna Medicare Advantage Facility/Ancillary Network Interest Forms for New York" href="/static/medicareproviders-cigna-com/docs/facility-network-interest-form-ny.pdf" target="_blank" rel="noopener">New York [PDF]</a></li> <li><a title="Cigna Medicare Advantage Facility/Ancillary Network Interest Forms for North Carolina and South 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Tennessee" href="/static/medicareproviders-cigna-com/docs/facility-network-interest-form-tn.pdf" target="_blank" rel="noopener">Tennessee [PDF]</a></li> <li><a title="Cigna Medicare Advantage Facility/Ancillary Network Interest Forms for Vermont" href="/static/medicareproviders-cigna-com/docs/facility-network-interest-form-vt.pdf" target="_blank" rel="noopener">Vermont [PDF]</a></li> </ul></div> </div> </div> <div data-ct-component="Accordion" class="accordion-panel panel"> <h5 class="accordion-panel-heading" role="tab" id="network-interest-forms---practitioner-4686"> <a data-target="#network-interest-forms---practitioner-panel-4686" aria-expanded="true" data-toggle="collapse" role="button" class="collapsed"> <svg class="arrow" aria-hidden="true"> <use xlink:href="/static/svgs/legacy/component-sprite.svg#el-caret-right"></use> </svg> <svg class="arrow-expanded" aria-hidden="true"> <use xlink:href="/static/svgs/legacy/component-sprite.svg#el-caret-down"></use> </svg> Network Interest Forms - Practitioner</a> </h5> <div aria-labelledby="network-interest-forms---practitioner-4686" role="tabpanel" id="network-interest-forms---practitioner-panel-4686" class="collapse"> <div class="accordion-panel-body"><ul class="link-lists list-no-indent" data-ct-header="English|Network Interest Forms - Practitioner"> <li><a title="Cigna Medicare Advantage Medical Practitioner Network Interest Forms for Alabama, North Florida, and Southern Mississippi" href="/static/medicareproviders-cigna-com/docs/practitioner-network-interest-form-al-nfl-sms.pdf" target="_blank" rel="noopener">Alabama, North Florida, and Southern Mississippi [PDF]</a><br />Note: This dynamic PDF form will not open and display properly in your browser.<br /><strong>To use this form as intended, right click on the link, chose “Save link as,” and download the PDF to your computer.</strong> Open the file in your PDF viewer application to fill out the form and submit your request.</li> <li><a title="Cigna Medicare Advantage Medical Practitioner Network Interest Forms for Arkansas" href="/static/medicareproviders-cigna-com/docs/practitioner-network-interest-form-ar.pdf" target="_blank" rel="noopener">Arkansas [PDF]</a></li> <li><a title="Cigna Medicare Advantage Medical Practitioner Network Interest Forms for Arizona" href="/static/medicareproviders-cigna-com/docs/practitioner-network-interest-form-az.pdf" target="_blank" rel="noopener">Arizona [PDF]</a></li> <li><a title="Cigna Medicare Advantage Medical Practitioner Network Interest Forms for Colorado, New Mexico, Oregon, Utah, and Washington" href="/static/medicareproviders-cigna-com/docs/practitioner-network-interest-form-co-nm-or-ut-wa.pdf" target="_blank" rel="noopener">Colorado, New Mexico, Oregon, Utah, and Washington [PDF]</a></li> <li><a title="Cigna Medicare Advantage Medical Practitioner Network Interest Forms for Connecticut" href="/static/medicareproviders-cigna-com/docs/practitioner-network-interest-form-ct.pdf" target="_blank" rel="noopener">Connecticut [PDF]</a></li> <li><a title="Cigna Medicare Advantage Medical Practitioner Network Interest Forms for Delaware, Maryland, New Jersey, Pennsylvania, and Washington DC" href="/static/medicareproviders-cigna-com/docs/practitioner-network-interest-form-mapa.pdf" target="_blank" rel="noopener">Delaware, Maryland, New Jersey, Pennsylvania, Virginia, and Washington DC [PDF]</a></li> <li><a title="Cigna Medicare Advantage Medical Practitioner Network Interest Forms for Central Florida" href="/static/medicareproviders-cigna-com/docs/practitioner-network-interest-form-cfl.pdf" target="_blank" rel="noopener">Florida - Central [PDF]</a></li> <li><a title="Cigna Medicare Advantage Facility/Ancillary Network Interest Forms for South Florida" href="/static/medicareproviders-cigna-com/docs/practitioner-network-interest-form-sfl.pdf" target="_blank" rel="noopener">Florida - South [PDF]</a></li> <li><a title="Cigna Medicare Advantage Medical Practitioner Network Interest Forms for Georgia " href="/static/medicareproviders-cigna-com/docs/practitioner-network-interest-form-ga.pdf" target="_blank" rel="noopener">Georgia [PDF]</a></li> <li><a title="Cigna Medicare Advantage Medical Practitioner Network Interest Forms for Illinois" href="/static/medicareproviders-cigna-com/docs/practitioner-network-interest-form-il.pdf" target="_blank" rel="noopener">Illinois [PDF]</a></li> <li><a title="Cigna Medicare Advantage Medical Practitioner Network Interest Forms for Kansas City" href="/static/medicareproviders-cigna-com/docs/practitioner-network-interest-form-kc.pdf" target="_blank" rel="noopener">Kansas City [PDF]</a></li> <li><a title="Cigna Medicare Advantage Medical Practitioner Network Interest Forms for New York" href="/static/medicareproviders-cigna-com/docs/practitioner-network-interest-form-ny.pdf" target="_blank" rel="noopener">New York [PDF]</a></li> <li><a title="Cigna Medicare Advantage Medical Practitioner Network Interest Forms for North Carolina and South Carolina" href="/static/medicareproviders-cigna-com/docs/practitioner-network-interest-form-nc-sc.pdf" target="_blank" rel="noopener">North Carolina and South Carolina [PDF]</a></li> <li><a title="Cigna Medicare Advantage Facility/Ancillary Network Interest Forms for Ohio" href="/static/medicareproviders-cigna-com/docs/practitioner-network-interest-form-oh.pdf" target="_blank" rel="noopener">Ohio [PDF]</a></li> <li><a title="Cigna Medicare Advantage Medical Practitioner Network Interest Forms for Oklahoma and Texas" href="/static/medicareproviders-cigna-com/docs/practitioner-network-interest-form-ok-tx.pdf" target="_blank" rel="noopener">Oklahoma and Texas [PDF]</a></li> <li><a title="Cigna Medicare Advantage Medical Practitioner Network Interest Forms for St. Louis" href="/static/medicareproviders-cigna-com/docs/practitioner-network-interest-form-st-louis.pdf" target="_blank" rel="noopener">St. Louis [PDF]</a></li> <li><a title="Cigna Medicare Advantage Medical Practitioner Network Interest Forms for Tennessee" href="/static/medicareproviders-cigna-com/docs/practitioner-network-interest-form-tn.pdf" target="_blank" rel="noopener">Tennessee [PDF]</a></li> <li><a title="Cigna Medicare Advantage Medical Practitioner Network Interest Forms for Vermont" href="/static/medicareproviders-cigna-com/docs/practitioner-network-interest-form-vt.pdf" target="_blank" rel="noopener">Vermont [PDF]</a></li> </ul></div> </div> </div> <div data-ct-component="Accordion" class="accordion-panel panel"> <h5 class="accordion-panel-heading" role="tab" id="part-b-drugs-biologics-4686"> <a data-target="#part-b-drugs-biologics-panel-4686" aria-expanded="true" data-toggle="collapse" role="button" class="collapsed"> <svg class="arrow" aria-hidden="true"> <use xlink:href="/static/svgs/legacy/component-sprite.svg#el-caret-right"></use> </svg> <svg class="arrow-expanded" aria-hidden="true"> <use xlink:href="/static/svgs/legacy/component-sprite.svg#el-caret-down"></use> </svg> Part B Drugs/Biologics</a> </h5> <div aria-labelledby="part-b-drugs-biologics-4686" role="tabpanel" id="part-b-drugs-biologics-panel-4686" class="collapse"> <div class="accordion-panel-body"><p><strong>Drugs/Biologics Part B Step Therapy Quick Reference Guides</strong></p> <p><strong>2025</strong></p> <ul> <li><a title="Drugs and Biologics Part B Step Therapy Requirement Quick Reference Guide - Cigna Healthcare Medicare Advantage; Effective April 1, 2025" href="/static/medicareproviders-cigna-com/docs/quick-reference-guide-part-b-step-therapy-2025-april.pdf" target="_blank" rel="noopener">Part B Step Therapy Quick Reference Guide [PDF]</a> Effective 4/1/2025</li> <li><a title="Drugs and Biologics Part B Step Therapy Requirement Quick Reference Guide - Cigna Healthcare Medicare Advantage; Effective January 1, 2025" href="/static/medicareproviders-cigna-com/docs/quick-reference-guide-part-b-step-therapy-2025-january.pdf" target="_blank" rel="noopener">Part B Step Therapy Quick Reference Guide [PDF]</a> Effective 1/1/2025</li> </ul> <p><strong>2024</strong></p> <ul> <li><a title="Drugs and Biologics Part B Step Therapy Requirement Quick Reference Guide - Cigna Healthcare Medicare Advantage; Effective October 1, 2024" href="/static/medicareproviders-cigna-com/docs/quick-reference-guide-part-b-step-therapy-2024-october.pdf" target="_blank" rel="noopener">Part B Step Therapy Quick Reference Guide [PDF]</a> Effective 10/1/2024</li> <li><a title="Drugs and Biologics Part B Step Therapy Requirement Quick Reference Guide - Cigna Healthcare Medicare Advantage; Effective July 1, 2024" href="/static/medicareproviders-cigna-com/docs/quick-reference-guide-part-b-step-therapy-2024-july.pdf" target="_blank" rel="noopener">Part B Step Therapy Quick Reference Guide [PDF]</a> Effective 7/1/2024</li> <li><a title="Drugs and Biologics Part B Step Therapy Requirement Quick Reference Guide - Cigna Healthcare Medicare Advantage; Effective April 1, 2024" href="/static/medicareproviders-cigna-com/docs/quick-reference-guide-part-b-step-therapy-2024-april.pdf" target="_blank" rel="noopener">Part B Step Therapy Quick Reference Guide [PDF]</a> Effective 4/1/2024</li> <li><a title="Drugs and Biologics Part B Step Therapy Requirement Quick Reference Guide - Cigna Healthcare Medicare Advantage; Effective January 1, 2024" href="/static/medicareproviders-cigna-com/docs/quick-reference-guide-part-b-step-therapy-2024-january.pdf" target="_blank" rel="noopener">Part B Step Therapy Quick Reference Guide [PDF]</a> Effective 1/1/2024</li> </ul> <p><strong>Drugs/Biologics Part B Precertification Forms</strong></p> <ul> <li><a title="Drugs/Biologics Part B Precertification Form - Cigna Healthcare Medicare Advantage" href="/static/medicareproviders-cigna-com/docs/precertification-form-drugs-biologics-part-b.pdf" target="_blank" rel="noopener">Drugs/Biologics Part B Precertification Form [PDF]</a></li> <li><a title="Durable Medical Equipment (DME) Diabetic Testing Supplies Request Drugs/Biologics Part B Precertification Form | Cigna Healthcare Medicare Advantage" href="/static/medicareproviders-cigna-com/docs/precertification-form-durable-medical-equipment-diabetic-testing-supplies.pdf" target="_blank" rel="noopener">Durable Medical Equipment (DME) Diabetic Testing Supplies Request [PDF]</a></li> </ul> <p><strong>Drugs/Biologics Part B Step Therapy Precertification Forms</strong></p> <ul> <li><a title="Avastin and Vegzelma Drugs/Biologics Part B Step Therapy Precertification Form | Cigna Healthcare Medicare Advantage" href="/static/medicareproviders-cigna-com/docs/precertification-form-part-b-step-therapy-avastin-vegzelma.pdf" target="_blank" rel="noopener">Avastin and Vegzelma [PDF]</a></li> <li><a title="Aveed, Testopel, Xyosted Drugs/Biologics Part B Step Therapy Precertification Form | Cigna Healthcare Medicare Advantage" href="/static/medicareproviders-cigna-com/docs/precertification-form-part-b-step-therapy-aveed-testopel-xyosted.pdf" target="_blank" rel="noopener">Aveed, Testopel, and Xyosted [PDF]</a></li> <li><a title="Durolane, Euflexxa, Gel-One, Gelsyn-3, Genvisc 850, Hyalgan, Hymovis, Sodium Hyaluronate 1%, Supartz FX, Synojoynt, Triluron, Trivisc, and Visco-3 Drugs/Biologics Part B Step Therapy Precertification Form | Cigna Healthcare Medicare Advantage" href="/static/medicareproviders-cigna-com/docs/precertification-form-part-b-step-therapy-durolane-visco-3.pdf" target="_blank" rel="noopener">Durolane, Euflexxa, Gel-One, Gelsyn-3, Genvisc 850, Hyalgan, Hymovis,<br />Sodium Hyaluronate 1%, Supartz FX, Synojoynt, Triluron, Trivisc, and Visco-3 [PDF]</a></li> <li><a title="Eylea, Lucentis, Beovu, Vabysmo, Byooviz, and Cimerli Drugs/Biologics Part B Step Therapy Precertification Form | Cigna Healthcare Medicare Advantage" href="/static/medicareproviders-cigna-com/docs/precertification-form-part-b-step-therapy-eylea-lucentis-beovu-vabysmo-byooviz-cimerli.pdf" target="_blank" rel="noopener">Eylea, Lucentis, Beovu, Vabysmo, Byooviz, and Cimerli [PDF]</a></li> <li><a title="Eylea, Eylea HD, Lucentis, Beovu, Vabysmo, Byooviz, Cimerli, Pavblu Drugs/Biologics Part B Step Therapy Precertification Form | Cigna Healthcare Medicare Advantage" href="/static/medicareproviders-cigna-com/docs/precertification-form-part-b-step-therapy-eylea-eylea-hd-lucentis-beovu-vabysmo-byooviz-cimerli-pavblu.pdf" target="_blank" rel="noopener">Eylea, Eylea HD, Lucentis, Beovu, Vabysmo, Byooviz, Cimerli, and Pavblu [PDF]</a> Effective 4/1/2025</li> <li><a title="Herceptin IV, Herceptin Hylecta, Herzuma, and Ontruzant Drugs/Biologics Part B Step Therapy Precertification Form | Cigna Healthcare Medicare Advantage" href="/static/medicareproviders-cigna-com/docs/precertification-form-part-b-step-therapy-herceptin.pdf" target="_blank" rel="noopener">Herceptin IV, Herceptin Hylecta, Herzuma, and Ontruzant [PDF]</a></li> <li>Immune Globulin <ul> <li><a title="Intravenous Immune Globulin Drugs/Biologics Part B Step Therapy Precertification Form | Cigna Healthcare Medicare Advantage" href="/static/medicareproviders-cigna-com/docs/precertification-form-part-b-step-therapy-intravenous-immune-globulin.pdf" target="_blank" rel="noopener">Intravenous Immune Globulin [PDF]</a></li> <li><a title="Subcutaneou Immune Globulin Drugs/Biologics Part B Step Therapy Precertification Form | Cigna Healthcare Medicare Advantage" href="/static/medicareproviders-cigna-com/docs/precertification-form-part-b-step-therapy-subcutaneous-immune-globulin.pdf" target="_blank" rel="noopener">Subcutaneous Immune Globulin [PDF]</a></li> </ul> </li> <li><a title="Monoferric, Feraheme, and Injectafer Drugs/Biologics Part B Step Therapy Precertification Form | Cigna Healthcare Medicare Advantage" href="/static/medicareproviders-cigna-com/docs/precertification-form-part-b-step-therapy-monoferric-feraheme-injectafer.pdf" target="_blank" rel="noopener">Monoferric, Feraheme, and Injectafer [PDF]</a></li> <li><a title="Myobloc Drugs/Biologics Part B Step Therapy Precertification Form | Cigna Healthcare Medicare Advantage" href="/static/medicareproviders-cigna-com/docs/precertification-form-part-b-step-therapy-myobloc.pdf" target="_blank" rel="noopener">Myobloc [PDF]</a></li> <li><a title="Neupogen, Granix, and Releuko Drugs/Biologics Part B Step Therapy Precertification Form | Cigna Healthcare Medicare Advantage" href="/static/medicareproviders-cigna-com/docs/precertification-form-neupogen-granix-releuko.pdf" target="_blank" rel="noopener">Neupogen, Granix, and Releuko [PDF]</a></li> <li><a title="PCSK9 Inhibitors, Leqvio Drugs/Biologics Part B Step Therapy Precertification Form | Cigna Healthcare Medicare Advantage" href="/static/medicareproviders-cigna-com/docs/precertification-form-part-b-step-therapy-pcsk9-inhibitors-leqvio.pdf" target="_blank" rel="noopener">PCSK9 Inhibitors, Leqvio [PDF]</a></li> <li><a title="Remicade Drugs/Biologics Part B Step Therapy Precertification Form | Cigna Healthcare Medicare Advantage" href="/static/medicareproviders-cigna-com/docs/precertification-form-part-b-step-therapy-remicade.pdf" target="_blank" rel="noopener">Remicade [PDF]</a></li> <li><a title="Rituxan and Rituxan Hycela Drugs/Biologics Part B Step Therapy Precertification Form | Cigna Healthcare Medicare Advantage" href="/static/medicareproviders-cigna-com/docs/precertification-form-part-b-step-therapy-rituxan-rituxan-hycela.pdf" target="_blank" rel="noopener">Rituxan and Rituxan Hycela [PDF]</a></li> <li><a title="Sandostatin LAR and Lanreotide Drugs/Biologics Part B Step Therapy Precertification Form | Cigna Healthcare Medicare Advantage" href="/static/medicareproviders-cigna-com/docs/precertification-form-part-b-step-therapy-sandostatin-lar-lanreotide-2024-october.pdf" target="_blank" rel="noopener">Sandostatin LAR and Lanreotide [PDF]</a></li> <li><a title="Saphnelo Drugs/Biologics Part B Step Therapy Precertification Form | Cigna Healthcare Medicare Advantage" href="/static/medicareproviders-cigna-com/docs/precertification-form-part-b-step-therapy-saphnelo-2024-october.pdf" target="_blank" rel="noopener">Saphnelo [PDF]</a></li> <li><a title="Vyepti Drugs/Biologics Part B Step Therapy Precertification Form | Cigna Healthcare Medicare Advantage" href="/static/medicareproviders-cigna-com/docs/precertification-form-part-b-step-therapy-vyepti.pdf" target="_blank" rel="noopener">Vyepti [PDF]</a></li> <li><a title="Ziextenzo, Fulphila, Fylnetra, Stimufend, and Rolvedon Drugs/Biologics Part B Step Therapy Precertification Form | Cigna Healthcare Medicare Advantage" href="/static/medicareproviders-cigna-com/docs/precertification-form-part-b-step-therapy-ziextenzo-fulphila-fylnetra-stimufend-rolvedon.pdf" target="_blank" rel="noopener">Ziextenzo, Fulphila, Fylnetra, Stimufend, and Rolvedon [PDF]</a></li> </ul></div> </div> </div> <div data-ct-component="Accordion" class="accordion-panel panel"> <h5 class="accordion-panel-heading" role="tab" id="practice-support-4686"> <a data-target="#practice-support-panel-4686" aria-expanded="true" data-toggle="collapse" role="button" class="collapsed"> <svg class="arrow" aria-hidden="true"> <use xlink:href="/static/svgs/legacy/component-sprite.svg#el-caret-right"></use> </svg> <svg class="arrow-expanded" aria-hidden="true"> <use xlink:href="/static/svgs/legacy/component-sprite.svg#el-caret-down"></use> </svg> Practice Support</a> </h5> <div aria-labelledby="practice-support-4686" role="tabpanel" id="practice-support-panel-4686" class="collapse"> <div class="accordion-panel-body"><ul class="link-lists list-no-indent" data-ct-header="English|Practice Support"> <li><a title="Cigna Healthcare Medicare Advantage Health Care Provider 360 Annual Wellness Exam Form" href="/static/medicareproviders-cigna-com/docs/360-exam-form.pdf" target="_blank" rel="noopener">360 Annual Wellness Exam [PDF]</a></li> <li><a title="Access and Availability Survey Standards for Medical Cigna Healthcare Medicare Advantage Providers" href="/static/medicareproviders-cigna-com/docs/access-availability-standards-survey-medical.pdf" target="_blank" rel="noopener">Access and Availability Survey Standards – Medical Providers [PDF]</a></li> <li><a title="Cigna HealthcareBehavioral Health Resources for Medicare Advantage Providers" href="/bhunit.html" target="_blank" rel="noopener">Behavioral Health</a></li> <li><a title="Cigna Healthcare Medicare Advantage Plans Customer ID Cards at a Glance" href="/static/medicareproviders-cigna-com/docs/customer-id-card-examples.pdf" target="_blank" rel="noopener">Cigna Healthcare 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CignaforHCP</a> <span style="color: #e35205;">(AZ Only)</span></li> <li><a title="Cigna HealthcareQuick Reference Guide for Medicare Advantage Providers" href="/quick-reference-guide" target="_blank" rel="noopener">Quick Reference Guide</a></li> <li><a title="Cigna HealthcareMedical Oncology Management Program Quick Reference Guide for Medicare Advantage Providers" href="/static/medicareproviders-cigna-com/docs/quick-reference-guide-oncology.pdf" target="_blank" rel="noopener">Quick Reference Guide – Oncology [PDF]</a></li> <li><a title="Cigna Healthcare2020 Special Needs Plans (SNPS) Model of Care (MOC) Training for Medicare Advantage Providers" href="https://campaigns.cigna.com/snp-moc/" target="_blank" rel="noopener">Special Needs Plans Model of Care Training </a></li> <li><a title="Cigna Healthcare Medicare Advantage Provider Updates" href="http://information.cigna.com/LP=207" target="_blank" rel="noopener">Stay Informed – Provider Updates</a></li> </ul></div> </div> </div> <div data-ct-component="Accordion" class="accordion-panel panel"> <h5 class="accordion-panel-heading" role="tab" id="prior-authorization-request-forms-4686"> <a data-target="#prior-authorization-request-forms-panel-4686" aria-expanded="true" data-toggle="collapse" role="button" class="collapsed"> <svg class="arrow" aria-hidden="true"> <use xlink:href="/static/svgs/legacy/component-sprite.svg#el-caret-right"></use> </svg> <svg class="arrow-expanded" aria-hidden="true"> <use xlink:href="/static/svgs/legacy/component-sprite.svg#el-caret-down"></use> </svg> Prior Authorization Request Forms</a> </h5> <div aria-labelledby="prior-authorization-request-forms-4686" role="tabpanel" id="prior-authorization-request-forms-panel-4686" class="collapse"> <div class="accordion-panel-body"><p><a title="Cigna Drug Prior Authorization Request Forms Coverage Determinations for Medicare" href="https://www.cigna.com/medicare/resources/customer-forms" target="_blank" rel="noopener">Drug Prior Authorization Request Forms Coverage Determinations</a></p> <p><a title="Inpatient Admission Notification Form - Cigna Medicare Advantage" href="/static/medicareproviders-cigna-com/docs/inpatient-admission-request.pdf" target="_blank" rel="noopener">Inpatient Admission Notification Form [PDF]</a></p> <p><strong>Prior Authorization and Precertification Request Forms</strong></p> <ul class="link-lists list-no-indent" data-ct-header="English|Prior Authorization Request Forms"> <li><a title="Cigna Generic Prior Authorization Request Form for Medicare Advantage Providers" href="/static/medicareproviders-cigna-com/docs/prior-authorization-request-form.pdf" target="_blank" rel="noopener">Basic/Generic Prior Authorization Request Form [PDF]</a></li> <li><a title="eviCore healthcare Durable Medical Equipment (DME) Precertification Request Form for Cigna Medicare Advantage Providers" href="/static/medicareproviders-cigna-com/docs/prior-authorization-request-form-durable-medical-equipment.pdf" target="_blank" rel="noopener">Durable Medical Equipment (DME) [PDF]</a></li> <li><a title="Durable Medical Equipment (DME) Cigna Prior Authorization Request Form for Medicare Advantage Providers in Arizona Only" href="/static/medicareproviders-cigna-com/docs/prior-authorization-request-form-durable-medical-equipment-az.pdf" target="_blank" rel="noopener">Durable Medical Equipment (DME) [PDF]</a> <span style="color: #e35205;">(AZ Only)</span></li> <li><a title="Genetic Testing Precertification Request Form for Cigna Medicare Advantage Providers" href="/static/medicareproviders-cigna-com/docs/prior-authorization-request-form-genetic-testing.pdf" target="_blank" rel="noopener">Genetic Testing [PDF]</a> Effective 1/1/2023</li> <li><a title="eviCore healthcare Home Health Care (HHC) Services Authorization Request Form for Cigna Medicare Advantage Providers" href="/static/medicareproviders-cigna-com/docs/prior-authorization-request-form-home-health-care.pdf" target="_blank" rel="noopener">Home Health Care 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You must download them to your computer prior to filling out.</span></dt> <dd>   1. Right click on the form link, chose “Save link as,” and download the PDF to your computer</dd> <dd>   2. Open the downloaded file in your computer’s PDF application</dd> <dd>   3. 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class="collapsed"> <svg class="arrow" aria-hidden="true"> <use xlink:href="/static/svgs/legacy/component-sprite.svg#el-caret-right"></use> </svg> <svg class="arrow-expanded" aria-hidden="true"> <use xlink:href="/static/svgs/legacy/component-sprite.svg#el-caret-down"></use> </svg> Prior Authorization Requirements</a> </h5> <div aria-labelledby="prior-authorization-requirements-4686" role="tabpanel" id="prior-authorization-requirements-panel-4686" class="collapse"> <div class="accordion-panel-body"><p><strong>2025</strong></p> <ul> <li><a href="/static/medicareproviders-cigna-com/docs/prior-authorization-requirements.pdf" target="_blank" title="Prior Authorization Requirements for dates of service on or after 1/1/2025 | Cigna Healthcare Medicare Advantage Providers" rel="noopener">Prior Authorization Requirements – January 2025 [PDF]</a> Effective 1/1/2025</li> </ul> <p><strong>2024</strong></p> <ul> <li><a href="/static/medicareproviders-cigna-com/docs/prior-authorization-requirements-2024-october.pdf" target="_blank" title="Prior Authorization Requirements for dates of service on or after 10/1/2024 | Cigna Healthcare Medicare Advantage Providers" rel="noopener">Prior Authorization Requirements – October 2024 [PDF]</a></li> <li><a href="/static/medicareproviders-cigna-com/docs/prior-authorization-requirements-2024-july.pdf" target="_blank" title="Prior Authorization Requirements for dates of service on or after 7/1/2024 | Cigna Healthcare Medicare Advantage Providers" rel="noopener">Prior Authorization Requirements – July 2024 [PDF]</a></li> <li><a href="/static/medicareproviders-cigna-com/docs/prior-authorization-requirements-2024-april.pdf" target="_blank" title="Prior Authorization Requirements for dates of service on or after 4/1/2024 | Cigna Healthcare Medicare Advantage Providers" rel="noopener">Prior Authorization Requirements – April 2024 [PDF]</a></li> <li><a href="/static/medicareproviders-cigna-com/docs/prior-authorization-requirements-2024-january.pdf" target="_blank" title="Prior Authorization Requirements for dates of service on or after 1/1/2024 | Cigna Healthcare Medicare Advantage Providers" rel="noopener">Prior Authorization Requirements – January 2024 [PDF]</a></li> </ul> <p><strong>2023</strong></p> <ul> <li><a href="/static/medicareproviders-cigna-com/docs/prior-authorization-requirements-2023-october.pdf" target="_blank" title="Prior Authorization Requirements for dates of service on or after 10/1/2023 | Cigna Healthcare Medicare Advantage Providers" rel="noopener">Prior Authorization Requirements – October 2023 [PDF]</a></li> <li><a href="/static/medicareproviders-cigna-com/docs/prior-authorization-requirements-2023-july.pdf" target="_blank" title="Prior Authorization Requirements for dates of service on or after 7/1/2023 | Cigna Healthcare Medicare Advantage Providers" rel="noopener">Prior Authorization Requirements – July 2023 [PDF]</a></li> <li><a href="/static/medicareproviders-cigna-com/docs/prior-authorization-requirements-2023-april.pdf" target="_blank" title="Prior Authorization Requirements for dates of service on or after 4/1/2023 | Cigna Healthcare Medicare Advantage Providers" rel="noopener">Prior Authorization Requirements – April 2023 [PDF]</a></li> <li><a href="/static/medicareproviders-cigna-com/docs/prior-authorization-requirements-2023-january.pdf" target="_blank" title="Prior Authorization Requirements for dates of service on or after 1/1/2023 | Cigna Healthcare Medicare Advantage Providers" rel="noopener">Prior Authorization Requirements – January 2023 [PDF]</a></li> </ul> <p><strong>2022</strong></p> <ul> <li><a href="/static/medicareproviders-cigna-com/docs/prior-authorization-requirements-2022-october.pdf" target="_blank" title="Prior Authorization Requirements for dates of service on or after 10/1/2022 | Cigna Healthcare Medicare Advantage Providers" rel="noopener">Prior Authorization Requirements – October 2022 [PDF]</a></li> <li><a href="/static/medicareproviders-cigna-com/docs/prior-authorization-requirements-2022-july.pdf" title="Prior Authorization Requirements for dates of service on or after 7/1/2022 | Cigna Healthcare Medicare Advantage Providers">Prior Authorization Requirements – July 2022 [PDF]</a></li> <li><a href="/static/medicareproviders-cigna-com/docs/prior-authorization-requirements-2022-april.pdf" title="Prior Authorization Requirements for dates of service on or after 4/1/2022 | Cigna Healthcare Medicare Advantage Providers">Prior Authorization Requirements – April 2022 [PDF]</a> - Updated June 1, 2022</li> <li><a href="/static/medicareproviders-cigna-com/docs/prior-authorization-requirements-2022-january.pdf" title="Prior Authorization Requirements for dates of service on or after 1/1/2022 | Cigna Healthcare Medicare Advantage Providers">Prior Authorization Requirements – January 2022 [PDF]</a></li> </ul> <p><strong>2021</strong></p> <ul> <li><a href="/static/medicareproviders-cigna-com/docs/prior-authorization-requirements-2021-october.pdf" title="Prior Authorization Requirements for dates of service on or after 10/1/2021 | Cigna Healthcare Medicare Advantage Providers">Prior Authorization Requirements – October 2021 [PDF]</a></li> <li><a href="/static/medicareproviders-cigna-com/docs/prior-authorization-requirements-2021-july.pdf" title="Prior Authorization Requirements for dates of service on or after 7/1/2021 | Cigna Healthcare Medicare Advantage Providers">Prior Authorization Requirements – July 2021 [PDF]</a></li> <li><a href="/static/medicareproviders-cigna-com/docs/prior-authorization-requirements-2021-april.pdf" title="Prior Authorization Requirements for dates of service on or after 4/1/2021 | Cigna Healthcare Medicare Advantage Providers">Prior Authorization Requirements – April 2021 [PDF]</a></li> <li><a href="/static/medicareproviders-cigna-com/docs/prior-authorization-requirements-2021-january.pdf" title="Prior Authorization Requirements for dates of service on or after 1/1/2021 | Cigna Healthcare Medicare Advantage Providers">Prior Authorization Requirements – January 2021 [PDF]</a></li> </ul> <p><strong>2020</strong></p> <ul> <li><a href="/static/medicareproviders-cigna-com/docs/prior-authorization-requirements-2020-october.pdf" title="Prior Authorization Requirements for dates of service on or after 10/1/2020 | Cigna Healthcare Medicare Advantage Providers">Prior Authorization Requirements – October 2020 [PDF]</a></li> <li><a href="/static/medicareproviders-cigna-com/docs/prior-authorization-requirements-2020-az.pdf">Prior Authorization Requirements (Arizona only) [PDF]</a></li> <li><a href="/static/medicareproviders-cigna-com/docs/prior-authorization-requirements-2020-july.pdf" title="Prior Authorization Requirements for dates of service on or after 7/1/2020 | Cigna Healthcare Medicare Advantage Providers">Prior Authorization Requirements – July 2020 [PDF]</a></li> <li><a href="/static/medicareproviders-cigna-com/docs/prior-authorization-requirements-2020-april.pdf" title="Prior Authorization Requirements for dates of service on or after 1/4/2020 | Cigna Healthcare Medicare Advantage Providers">Prior Authorization Requirements – April 2020 [PDF]</a></li> <li><a href="/static/medicareproviders-cigna-com/docs/prior-authorization-requirements-2019.pdf" title="Prior Authorization Requirements for dates of service on or after 1/1/2020 | Cigna Healthcare Medicare Advantage Providers">Prior Authorization Requirements – January 2020 [PDF]</a></li> </ul> <p><strong>2019</strong></p> <ul> <li><a href="/static/medicareproviders-cigna-com/docs/prior-authorization-requirements-2019-october.pdf" title="Prior Authorization Requirements for dates of service on or after 10/1/2019 | Cigna Healthcare Medicare Advantage Providers">Prior Authorization Requirements – October 2019 [PDF]</a></li> </ul></div> </div> </div> <div data-ct-component="Accordion" class="accordion-panel panel"> <h5 class="accordion-panel-heading" role="tab" id="provider-information-change-forms-4686"> <a data-target="#provider-information-change-forms-panel-4686" aria-expanded="true" data-toggle="collapse" role="button" class="collapsed"> <svg class="arrow" aria-hidden="true"> <use xlink:href="/static/svgs/legacy/component-sprite.svg#el-caret-right"></use> </svg> <svg class="arrow-expanded" aria-hidden="true"> <use xlink:href="/static/svgs/legacy/component-sprite.svg#el-caret-down"></use> </svg> Provider Information Change Forms</a> </h5> <div aria-labelledby="provider-information-change-forms-4686" role="tabpanel" id="provider-information-change-forms-panel-4686" class="collapse"> <div class="accordion-panel-body"><ul class="link-lists list-no-indent" data-ct-header="English|Provider Information Change Forms"> <li><a title="Cigna Information Change Forms for Medicare Advantage Providers in Alabama, Georgia, North Carolina, North Florida, South Carolina,and South Mississippi" href="/static/medicareproviders-cigna-com/docs/provider-information-change-form-al-ga-nfl-sms-nc-sc.pdf" target="_blank" rel="noopener">Alabama, Georgia, North Carolina, North Florida, South Carolina,and South Mississippi [PDF]</a></li> <li><a title="Cigna Information Change Forms for Medicare Advantage Providers in Arizona" href="/static/medicareproviders-cigna-com/docs/provider-information-change-form-az.pdf" target="_blank" rel="noopener">Arizona [PDF]</a></li> <li><a title="Cigna Information Change Forms for Medicare Advantage Providers in Colorado" href="/static/medicareproviders-cigna-com/docs/provider-information-change-form-co-nm-ut.pdf" target="_blank" rel="noopener">Colorado, New Mexico, and Utah [PDF]</a></li> <li><a title="Cigna Information Change Forms for Medicare Advantage Providers in Delaware, Maryland, New Jersey, Pennsylvania, and Washington DC" href="/static/medicareproviders-cigna-com/docs/provider-information-change-form-mapa.pdf" target="_blank" rel="noopener">Delaware, Maryland, New Jersey, Pennsylvania, and Washington DC [PDF]</a></li> <li><a title="Cigna Information Change Forms for Medicare Advantage Providers in Illinois" href="/static/medicareproviders-cigna-com/docs/provider-information-change-form-il.pdf" target="_blank" rel="noopener">Illinois [PDF]</a></li> <li><a title="Cigna Information Change Forms for Medicare Advantage Providers in Kansas City and Missouri" href="/static/medicareproviders-cigna-com/docs/provider-information-change-form-ks-mo.pdf" target="_blank" rel="noopener">Kansas City and Missouri [PDF]</a></li> <li><a title="Cigna Information Change Forms for Medicare Advantage Providers in Tennessee" href="/static/medicareproviders-cigna-com/docs/provider-information-change-form-tn.pdf" target="_blank" rel="noopener">Tennessee [PDF]</a></li> <li><a title="Cigna Information Change Forms for Medicare Advantage Providers in Texas " href="/static/medicareproviders-cigna-com/docs/provider-information-change-form-tx.pdf" target="_blank" rel="noopener">Texas [PDF]</a></li> <li><a title="Cigna Information Change Forms for Medicare Advantage Providers in Texas MMP/Texas StarPlus" href="/static/medicareproviders-cigna-com/docs/provider-information-change-form-txmmp-txsp.pdf" target="_blank" rel="noopener">Texas MMP/Texas StarPlus [PDF]</a></li> </ul></div> </div> </div> <div data-ct-component="Accordion" class="accordion-panel panel"> <h5 class="accordion-panel-heading" role="tab" id="provider-manuals-and-regulatory-highlights-guide-4686"> <a data-target="#provider-manuals-and-regulatory-highlights-guide-panel-4686" aria-expanded="true" data-toggle="collapse" role="button" class="collapsed"> <svg class="arrow" aria-hidden="true"> <use xlink:href="/static/svgs/legacy/component-sprite.svg#el-caret-right"></use> </svg> <svg class="arrow-expanded" aria-hidden="true"> <use 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Medicare Advantage Providers" href="/static/medicareproviders-cigna-com/docs/regulatory-highlights-guide.pdf" target="_blank" rel="noopener">Regulatory Highlights Guide – 2025 [PDF]</a></li> </ul> <p><strong>2024</strong></p> <ul class="link-lists list-no-indent"> <li><a title="2024 Cigna Healthcare Medicare Advantage Participating Provider Manual" href="/static/medicareproviders-cigna-com/docs/medicare-provider-manual-2024.pdf" target="_blank" rel="noopener">Participating Provider Manual – 2024 [PDF]</a></li> </ul></div> </div> </div> <p class="tab-content"> <a data-offset="120" data-duration="700" data-target="#accordion-light-4686" class="back-to-top" href="#">Back to Top</a> </p> </div> </div> </div>  </div> </div> </div> <div class="ls-area col-xs-12 col-sm-3" id="ls-row-2-col-1-row-2-area-2"> <div class="ls-area-body" id="ls-gen12638575-ls-area-body"> <div class="ls-cmp-wrap ls-1st" id="w1709087630147">  <div class="iw_component" id="1709087630147"><div data-ct-component="Body" 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