Historically, for certain business units and types of appeals, Cigna has offered second-level appeals to health care professionals who were not satisfied with the resolution of a first-level review. Please be aware that beginning July 1, 2013, Cigna will no longer offer second-level appeals. All appeals will follow a thorough single appeal review process and will be completed within 60 days. This change establishes a consistent approach for health care professionals across Cigna’s network.
As a reminder, all appeals should be initiated in writing within 180 calendar days of the date of the initial payment or denial decision. If the appeal relates to a payment that we adjusted, the appeal should be initiated within 180 calendar days of the date of the last payment adjustment.
Patients are still entitled to second level appeals per ERISA guidelines, so remember to include an assignment of benefits when completing a second level appeal on behalf of the patient.
Health care professionals should submit all appeal requests on a “Request for Provider Payment Review Form,” which can also be found on the Cigna for Health Care Professionals website at (CignaforHCP.com > Resources > Forms Center > Medical Forms). This form will help Cigna understand the circumstances around your appeal request in order to conduct that thorough review.
For additional information on how to submit an appeal, please review the Claim Adjustment & Appeals Guidelines on the Cigna for Health Care Professionals website (CignaforHCP.com >Resources > Clinical Reimbursement Policies and Payment Policies > Claims Appeals Policies and Procedures > Appeal Policy and Procedures).