Cigna Providers & Facilities
Authorizations
![girl-with-pink-cast girl-with-pink-cast](/content/dam/kporg/support/cpp/girl-pink-cast.jpg)
Authorization Details for an HMO, EPO, POS 2-Tier Member:
Cigna Healthcare PPO Network Providers for urgent or emergency care outside of Kaiser Permanente's service state (California, Colorado, District of Columbia, Georgia, Hawaii, Maryland, Oregon, Virginia, and Washington) are to contact Kaiser Permanente as soon as possible for precertification or authorization questions at Kaiser Permanente's dedicated phone line for Cigna Healthcare PPO providers: 888.831.0761.
Adverse benefit decisions can be appealed by following the instructions on the back to the member’s Adverse Benefit Determinations notice:
![Cigna card](/content/dam/kporg/support/cpp/cpp-cigna-um-appeals-addresses.jpg)
![Cigna card](/content/dam/kporg/support/cpp/cpp-cigna-bh-um-appeals-addresses.jpg)
Cigna Healthcare PPO Network Providers should check eligibility and benefits to determine covered services, send claims, and submit precertification requests as instructed on the ID card.
Authorization Details for a PPO & 3-Tier POS Member:
Cigna Healthcare PPO Network Providers providing care outside of Kaiser Permanente states (outside of California, Colorado, District of Columbia, Georgia, Hawaii, Maryland, Oregon, Virginia, and Washington) are to contact Kaiser Permanente as soon as possible for precertification or authorization questions at Kaiser Permanente's dedicated phone line for Cigna Healthcare PPO providers: 888.831.0761.
Adverse benefit decisions can be appealed by following the instructions on the back to the member’s Adverse Benefit Determinations notice:
![Cigna card](/content/dam/kporg/support/cpp/cpp-cigna-um-appeals-addresses.jpg)
![Cigna card](/content/dam/kporg/support/cpp/cpp-cigna-bh-um-appeals-addresses.jpg)
Cigna Healthcare PPO Precertification List:
Below is a general list of procedures for members on an OOA/PPO/3-Tier POS plan that require a Cigna Precertification when using in-network benefits outside of a KP State:
PROCEDURE | PRECERTIFICATION REQUIREMENTS | PROCEDURE | PRECERTIFICATION REQUIREMENTS |
Chiropractic Services | Yes | Physical and Occupational Therapy | No, but benefit limits apply |
Cochlear Implants | No, but benefit limits apply | Diagnostic Radiology | Yes |
DME/Orthodontics & Prosthetics | Yes | Erectile Dysfunction | Yes, pharmacy benefit exclusions may apply & should be requested through MedImpact |
Gastric Bypass | Yes | Home Health Care | Yes |
Home Infusion Therapy | Yes | Injectable Medication | Yes |
Oral Pharynx Procedures | Yes | Outpatient Procedures | Yes |
Potential/Experimental/ | Yes | Speech Therapy | No, but benefit limits apply |
Investigational/Unproven | |||
Spinal Procedures | Yes | Therapeutic Radiology | Yes |
Transplants | Yes, Kaiser Permanente UM approval is required | Unlisted Procedures | Yes, benefit exclusions may apply |
Click on the following link to view the complete list of services that require precertification.
Note: Please be advised that Kaiser Permanente members are not subject to Cigna’s entire list of services that require a precertification & its entirety. As described above Cigna Healthcare PPO providers are to contact Kaiser Permanente as soon as possible for precertification or authorization questions at 888.831.0761.
Cigna Healthcare PPO Network Providers should check eligibility and benefits to determine covered services, send claims, and submit precertification requests as instructed on the ID card.
*The Cigna Healthcare PPO Network refers to the health care providers (doctors, hospitals, specialists) contracted as part of the Cigna PPO for Shared Administration. Cigna Healthcare is an independent company and not affiliated with Kaiser Foundation Health Plan, Inc., and its subsidiary health plans. Access to the Cigna Healthcare PPO Network is available through Cigna Healthcare’s contractual relationship with the Kaiser Permanente health plans. The Cigna Healthcare PPO Network is provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company. The Cigna Healthcare name, logo, and other marks are owned by Cigna Intellectual Property, Inc.
**Eligibility Exceptions: The Cigna Healthcare PPO Network* enhanced experience for our members is not available to:
- HMO, EPO, PPO, & POS members enrolled in coverage issued by Kaiser Foundation Health Plan of Washington and Kaiser Foundation Health Plan of Washington Options, Inc.
- PPO and POS 3-Tier members enrolled in coverage issued by Kaiser Foundation Health Plan of Northwest.
- Medicare members
- Medicaid members (Medi-Cal in California)
***Kaiser Permanente Insurance Company (KPIC) is a subsidiary of Kaiser Foundation Health Plan, Inc. (KFHP).