Prior Authorization Process: Behavioral Health Services


Cigna-HealthSpring maintains requirements for provider to obtain Prior Authorization for certain Behavioral Health Services.

 

Services that Require Prior Authorization

Physical Health Precertification List - Effective 9/1/2017 (To be update on our STAR+PLUS provider manual)

 
How to request a Prior Authorization for Behavioral Health Services
 
There are three ways to request a prior authorization.
  • Fax a Prior Authorization Form for Behavioral Health Services to Cigna-HealthSpring at the applicable fax number listed below.

    • Outpatient Behavioral Health:  877-809-0787
    • Inpatient Behavioral Health:  877-809-0786

  • Request a Prior Authorization for Behavioral Health Services online through Cigna-HealthSpring's Provider Portal.

  • Speak with a Cigna-HealthSpring representative in the Prior Authorization Department at 1-877-725-2688.

     
 

Prior authorization process for Behavioral Health Services

Cigna-HealthSpring prioritizes prior authorization requests according to medical necessity. If a prior authorization request is approved, Cigna-HealthSpring issues an authorization number that should be used for billing. Cigna-HealthSpring faxes the approved Prior Authorization Request Form and the authorization number to the requesting provider according to the following timeframes:
  • Standard Request - If all required information is submitted at the time of the request, Cigna-HealthSpring will respond to a Prior Authorization Request Form within three (3) business days of receipt of the request.

  • Expedited Request - An expedited request can be requested if a Provider believes that waiting for a decision under the standard request timeframe could place the Member’s life, health, or ability to regain maximum function in serious jeopardy. To request an expedited authorization, Providers should call 877-725-2688.

  • Emergency Admissions & Services - Prior authorization is not required for Emergency Services. However, Providers must notify Cigna-HealthSpring of Emergency Services within twenty-four (24) hours or by the next business day, whichever is later.

  • Post-Stabilization Request - Post-stabilization requests can be made for covered services related to an Emergency Medical Condition provided after a Member has been stabilized. Cigna-HealthSpring will respond to post-stabilization requests within one (1) hour.

Limits of Authorization - Authorizations for Outpatient Behavioral Health Services are usually issued for thirty (30) days.

 

Prior Authorization Forms – Behavioral Health Services

Cigna-HealthSpring maintains the following Prior Authorization Forms for Behavioral Health Services

 

Requests for authorization that are made after hours are reviewed the next business day.


 
To determine the status of an authorization request, call the Prior Authorization Department at 1-877-725-2688.