Cigna Appeal Form: Payment Review, Evernorth and HealthSpring

What is the Request for Health Care Professional Payment Review? It is the written provider appeal form for commercial medical claims: you tick the reason box, attach the EOB or EOP plus records, and mail it to the National Appeals Unit post office box that matches the indicator printed on the patient's ID card.

Written for participating and out-of-network practices and billers working a denied or underpaid commercial claim. Therapists who hand clients a superbill should note that member-filed claims are appealed by the member, not the practice.

Undeny's Take

Cigna is the payer where the phone call genuinely matters. Its own appeals page says timely filing, incomplete claim and fee schedule problems are often fixed by a real-time adjustment on the call, and a rep who cannot fix it tells you your appeal rights. Make the call, write down the reference number and the rep's name, and put both in the appeal if it comes to that. Then treat the written appeal as your only shot: Cigna's commercial process is one internal review followed by arbitration, so there is no second-level appeal to hold evidence back for. For behavioral health claims, know that Evernorth refuses appeals submitted by automation, so a tool like ours drafts the letter and a person on your team submits it.

Call First: The Real-Time Adjustment Step

Before starting an appeal, Cigna asks providers to call Customer Service at the number on the back of the patient's ID card. Many denials tied to timely filing, incomplete submissions, and contract or fee schedule disputes can be adjusted during that call by supplying the requested information. Fee schedule or reimbursement terms that affect multiple patients do not need individual appeals; Cigna's form points those to Customer Service or your Experience Manager.

From Phone Call to Arbitration

Step	What Cigna calls it	Deadline	Response
1	Customer Service call (real-time adjustment)	None published	On the call
2	Online claim reconsideration (coding edit denials)	No separate deadline published	Standard adjustment turnaround
3	Health care provider appeal (payment review)	180 calendar days from the initial payment or denial notice, or from the last payment adjustment	Review in 60 days; notice within 75 business days
4	Arbitration	Within one year of the letter with the final internal review decision	Per your agreement or the AHLA ADR Service

Cigna's appeal policy describes a single-level internal appeal for practitioner disputes. Overturned decisions arrive as a reprocessed claim on the EOP; upheld decisions arrive as an appeal denial letter listing any further rights. If you miss the appeal or arbitration window, Cigna's last determination becomes final, and you cannot bill the patient for the denied amount.

Provider appeal or customer appeal?

Cigna splits denials by who appeals. No-precertification claim denials and reimbursement denials (bundling, mutually exclusive, incidental, modifier) are health care provider appeals. Precertification denials for services not yet given, benefit denials, and maximum reimbursable amount disputes are customer appeals, which a provider can file on the patient's behalf. Medical necessity, experimental or investigational, and inpatient facility denials can go either way. Some customer-path cases offer an external review by an Independent Review Organization, and the provider needs the patient's approval to request it.

California's separate dispute policy

California providers follow Cigna's California Dispute Resolution Policy, which allows 365 calendar days from the initial payment or denial notice, or from the adjustment, to start a written dispute.

Filling Out the Payment Review Form

Download the Request for Health Care Professional Payment Review linked from Cigna's appeals and disputes page. Complete every field and tick the box for the appeal reason. Include:

• The original EOB or EOP, or the letter that requested more information.
• Documentation showing why the decision should be overturned, such as medical records or an operative report.
• Your TIN and NPI, whether you are contracted, the subscriber ID, patient date of birth, dates of service, claim number, and billed and paid amounts.
• If you send only a letter, state in it that this is a Health Care Professional Appeal.

The Cigna appeal mailing address depends on the patient's ID card. If the card shows the "GWH-Cigna" or "G" indicator, mail to Cigna Healthcare Inc. National Appeals Unit (NAO), PO Box 188062, Chattanooga, TN 37422. For all other commercial appeals, use Cigna Healthcare Inc. National Appeals Unit (NAO), PO Box 188011, Chattanooga, TN 37422. Appeals involving EviCore services or Express Scripts have their own addresses on that page. Corrected claims do not go to either appeals box: Cigna's form sends them to the claim address on the back of the ID card.

Online Claim Reconsideration in CignaforHCP

Cigna's appeals page does not list a separate paper Cigna reconsideration form for commercial claims: reconsiderations of coding-edit denials run through the online tool, and written appeals use the payment review form.

1. Confirm your CignaforHCP.com user has claims access plus the Reconsideration entitlement.
2. Open the claim; it must be finalized (paid, denied, processed or duplicate) for the Start a Reconsideration button to appear.
3. Answer the questionnaire; your answers decide whether the request goes to the adjustment team or the national appeals team.
4. Add notes and attach up to 10 files of up to 64MB each.
5. Submit the draft within five calendar days, and remember only one request can be open per claim, with a maximum of five per claim.
6. Send corrections as a corrected claim instead; Cigna's guide says corrections cannot be submitted through the reconsideration tool.

Evernorth Behavioral Health Appeals

Evernorth Behavioral Health, a Cigna Group subsidiary, is the behavioral network for Cigna Healthcare plans and publishes its own Administrative Guidelines. This is the section most therapy practices need:

• Payment appeals: initiate in writing within 180 calendar days of the initial payment or denial decision, or of the last payment adjustment. Call Provider Services at 800.926.2273 first. Most appeals are resolved within 60 calendar days, with notice within 75 days unless state law differs.
• How to submit: through Provider.Evernorth.com, or by mail to Evernorth Appeals, PO Box 188064, Chattanooga, TN 37422, with the Behavioral Appeals Cover Sheet.
• Human submission rule: Evernorth does not accept appeals sent by automation software or automated e-fax; each appeal must be submitted by a person, including when a billing service files it.
• Clinical (medical necessity) appeals: first level within 180 calendar days of the claim denial; second level within 60 days of receiving the first-level decision letter.
• Out-of-network providers: some standard appeals need an Appointment of Representative form signed by the patient, and payment disputes where the patient is held harmless need the patient's written authorization.

HealthSpring Now Runs the Former Medicare Book

HealthSpring is part of Health Care Service Corporation, which purchased Cigna's Medicare business in 2025; HealthSpring's provider FAQ says Cigna Medicare, including Medicare Advantage, is now HealthSpring, and existing Cigna Medicare contracts carry over. Do not use Cigna commercial deadlines or addresses for these claims. HealthSpring's 2026 manuals state:

• Contracted providers, claim dispute or reconsideration (coordination of benefits, timely filing, missing information): up to 180 days from the claim payment date.
• Contracted providers, appeal: one level, within 65 days of the original decision unless your agreement says otherwise; review can take up to 60 days. The Cigna HealthSpring appeal form for contracted providers is HealthSpring's Postservice Appeal and Claim Dispute Form.
• Non-contracted providers: appeals follow 42 CFR 422 Subpart M and need a signed Waiver of Liability, which must be signed by the provider, not a billing agency. Use the Noncontracted Provider Appeals and Disputes Form.
• Portal: Availity Essentials, payer space HealthSpring Medicare Advantage, payer ID 52192.

90 Days In-Network, 180 Days Out

Cigna publishes its commercial filing limits on its public claims page, and Evernorth and HealthSpring publish theirs in their manuals.

Claim type	Published limit
Participating provider, original claim	90 days after the date of service
Out-of-network provider, original claim	180 days after the date of service
Consecutive-day services	Counted from the last date of service
Cigna as secondary payer	Counted from the processing date on the primary carrier's EOB or EOP
Evernorth behavioral health	90 days of the date of service, or as your Provider Agreement defines
HealthSpring, in-network	Per contract; the manual cites 180 days from the initial date of service
HealthSpring, out-of-network	365 days from the date of service

Exceptions include a longer period required by law, extra time in your provider agreement, and a timely original claim that Cigna asked you to supplement. Cigna does not publish a separate corrected-claim window, and its page warns that a resubmission Cigna did not request, and that is not an appeal, is held to the filing limit. HealthSpring adds that appeals do not extend timely filing, even when a won appeal requires a corrected claim. Your Cigna contract also bars balance billing for claims denied as late. See CO-29 timely filing denials for the proof packet.

Habits That Get Payment Reviews Upheld

• Skipping the Customer Service call, then waiting 60 days for a fix that one call could have made.
• Mailing to the wrong National Appeals Unit box because nobody checked the ID card indicator.
• Sending a corrected claim to the appeals address, or trying to push it through the reconsideration tool.
• Holding back records for a second level that does not exist; the next stop is arbitration.
• Filing a bundling or modifier fight without the coding rationale, a common CO-97 bundling mistake.
• Letting software auto-submit Evernorth appeals.

Frequently Asked Questions

What is the Cigna provider appeal form?

Commercial medical claims use the Request for Health Care Professional Payment Review, mailed with the EOB or EOP and supporting records. A letter alone is accepted if it states it is a Health Care Professional Appeal. Behavioral health appeals use Evernorth's Behavioral Appeals Cover Sheet, and HealthSpring Medicare claims use HealthSpring's own forms.

How long do providers have to file a Cigna appeal?

Commercial appeals are due within 180 calendar days of the initial payment or denial notice, or of the last payment adjustment if Cigna adjusted the payment. Cigna completes the review in 60 days and sends notice within 75 business days. California providers have 365 calendar days under Cigna's California policy.

What is the Cigna timely filing limit?

Participating providers must file within 90 days after the date of service, and out-of-network providers within 180 days. Consecutive-day services count from the last date of service, and secondary claims count from the primary payer's EOB processing date. Evernorth behavioral health also uses 90 days unless your agreement says otherwise.

Is there a Cigna corrected claim timely filing limit?

Cigna does not publish a separate corrected-claim window. Its claims page says a resubmission that Cigna did not request, and that is not an appeal, is held to the normal filing limit of 90 days for participating providers or 180 days out of network. Send corrected claims to the claim address on the ID card, not through the reconsideration tool.

Does Cigna have a second-level provider appeal?

Not for commercial payment disputes. Cigna describes a single internal appeal, after which you may request arbitration within one year of the final internal decision letter. Evernorth clinical appeals and some customer appeals are different and can have a second level or an external review.

Where do former Cigna Medicare Advantage claims get appealed now?

Through HealthSpring, which bought Cigna's Medicare business in 2025. Contracted providers have one appeal level due within 65 days of the original decision, plus a reconsideration or claim dispute within 180 days of the payment date. Non-contracted providers must include a Waiver of Liability signed by the provider.

Can I use software to submit Evernorth behavioral health appeals?

No. Evernorth's Administrative Guidelines say appeals may not be submitted through automation software or automated electronic fax, and each appeal must be submitted by a person. You can still draft the letter with a tool, as long as a staff member submits it.

Informational only, not legal, medical, or billing advice. Verify against current Cigna, Evernorth or HealthSpring policy, your provider agreement, and the patient's plan before filing.

Turn the Denial Into a Payment Review Letter

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