Cigna Healthcare

Standard filing limit

90 days

Counted from

date of service

Appeal filing limit

180 days

Appeal window from

eob date

Notes

Participating provider claims within 90 days of service; out-of-network within 180 days (official CHCP policy). Exceptions: applicable law, provider agreement, and COB (counted from the primary carrier's EOB/EOP processing date).

Provider portal

https://cignaforhcp.cigna.com/ ↗ (opens in a new tab)Copy●Verified · August 2026Verified Aug 16, 2026 · Official web pageView source ↗ (opens in a new tab)

Provider portal for authorizations, referrals, claims and appeals.

Every contact is individually source-tracked and shows the date it was last verified. A green “Verified” badge only appears when a source and verification date exist.

Authorization

Not yet published for this entry. Prior authorization requirements, channels and retro-authorization rules are published only when verified against a source.

Required

Not stated

Portal

https://www.cigna.com/health-care-providers/coverage-and-claims/referrals

Retro referral

Not stated

Notes

Referral requirements depend on the member's benefit plan: HMO and Network Plans require a PCP referral for specialty care (in-network providers only); POS Plans require a PCP referral for in-network specialty care (out-of-network without a referral, but in-network referrals give the highest benefit levels); Open Access, PPO and Indemnity Plans never need referrals. All plans have open access for participating OB/GYN visits. PCPs must provide a written referral, note it in the patient's medical record, and the specialty provider must also note it. An Out-of-Network Referral Disclosure Form is required for each non-participating-provider referral except emergencies and pre-approved situations.

Level 1

Method

mail

Address

Cigna Healthcare Inc. National Appeals Unit (NAO), PO Box 188011, Chattanooga, TN 37422 (see official appeals page for GWH-Cigna and EviCore/Express Scripts variants)

Portal

https://www.cigna.com/health-care-providers/coverage-and-claims/appeals-disputes

Fax

877-852-4070 (Express Scripts clinical appeals)

Typical turnaround

Review completed in 60 days; notification within 75 business days

External review

Available

Yes

Process

Arbitration may be used as a final resolution step for payment disputes (AHLA ADR Service), subject to the provider agreement.

Medical records

Required

Itemized bill

Not stated

Operative report

Required

Other required

Original EOB, EOP, or letter requesting additional information, Completed Request for Health Care Provider Payment Review form

Notes

Provider appeals must include the completed Request for Health Care Provider Payment Review form, the original EOB/EOP or additional-information letter, and documentation supporting why the decision should be overturned (e.g., operative reports or medical records). Appeals must be filed within 180 calendar days of the initial payment or denial notice (or the last payment adjustment); the review is completed in 60 days.

Common CARCs

19729509697

Common RARCs

MA119N29N386M25N19N20M2N390

Top reasons

Precertification / prior authorization / notification absent (CARC 197) — the payer documents authorization requirements for covered services.; Timely filing (CARC 29) — Cigna documents a 90-day filing window from the date of service for participating providers (180 days out-of-network) (paired RARC MA119: provider-level adjustment for late claim filing).; Not medically necessary (CARC 50) — Cigna documents medical-necessity denials as a provider-appealable scenario (paired RARCs N386 NCD-based decision, M25 level of service not substantiated, N29 missing documentation).; Non-covered charge / benefit denial (CARC 96) — Cigna documents benefit denials (e.g., exclusion, limitation, administration) as a customer-appeal scenario rather than a provider appeal.; Bundled / included in another service (CARC 97) — Cigna documents claim-reimbursement denials including mutually exclusive, incidental, or bundling denials and modifier reimbursements (paired RARCs N19 incidental to primary procedure, N20 not payable with another same-date service, M2 not separately payable as inpatient, N390 cannot be billed separately).