Tip for Cigna MNR (plan-specific)

Review Cigna's Coverage Position documents before submitting to understand their criteria

Tip for Cigna MNR (plan-specific)

Document why standard/formulary alternatives are insufficient for this specific patient

Tip for Cigna MNR (plan-specific)

For complex cases, proactively request a peer-to-peer discussion with Cigna's medical reviewer

InsurancemoderateDoctor signature required

Cigna Medical Necessity Review Request

Cigna MNR (plan-specific) · Cigna Healthcare

Cigna-specific medical necessity review request for services requiring clinical review. Includes patient clinical information, treatment history, and justification for the requested service or medication.

Form Details

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Where to Submit This Form

🌐

Cigna Provider Portal (CignaforHCP)

https://cignaforhcp.cigna.com/

Submit through the provider portal for electronic review.

📠

Fax to Cigna Medical Necessity Review

Fax: 800-768-4695

Filing Deadline

Submit before the service is performed. Retrospective reviews accepted within plan-specified timeframes.

Required Attachments

📎 Completed Cigna medical necessity review request form
📎 Office notes documenting the clinical rationale
📎 History of previous treatments and their outcomes
📎 Peer-reviewed literature supporting the requested service (if applicable)

Processing Time

Standard: 15 calendar days. Urgent: 72 hours. Concurrent: 24 hours for inpatient stays.

What Happens Next

Cigna reviews the request against their coverage policies. Approved requests receive an authorization number. Denials are issued in writing with appeal instructions.

Tips for This Form

✓ Review Cigna's Coverage Position documents before submitting to understand their criteria
✓ Document why standard/formulary alternatives are insufficient for this specific patient
✓ For complex cases, proactively request a peer-to-peer discussion with Cigna's medical reviewer

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