PRIOR AUTHORIZATION REQUIREMENTS

OUTPATIENT CARE BELOW ELECTIVE INPATIENT AND OUTPATIENT CARE

$400 USD (or equivalent local currency) OVER $400 USD (or equivalent local currency)
3 BUSINESS DAYS TO
4 WEEKS PRIOR TO SERVICE IF AFTER DISCHARGE
ALL INFORMATION IS COMPLETE

HEALTH CARE
PROVIDER Informs Cigna on the treatment and Sends the invoice to Cigna,
cost estimate, using the Guarantee indicating the full amount and
of Payment request form via the amount paid by the patient
authorization@Cigna.com. via bills@Cigna.com.
› To confirm the customer is active and any
QBOK: Sends the discharge report
patient responsibility, check Cigna Envoy® at
preapprovalMena@Cigna.com to Cigna.
www.CignaEnvoy.com.
› Collect any patient responsibility only.
Remaining balance to be charged to
Cigna directly.
CIGNA
› Submit invoice to Cigna Global Health Pays the invoice to the health
Benefits®. Sends a Guarantee of Payment to care provider.
the provider and the patient within Sends a settlement note (a detail
48 hours on request. of the payment) to the patient
and the health care provider.

DIRECT PAYMENT BASED ON DIRECT PAYMENT BASED ON GUARANTEE OF PAYMENT.

VERIFICATION OF BENEFITS.
IN CASE OF EMERGENCY, PLEASE CALL THE APPROPRIATE CIGNA
REGIONAL NUMBER IMMEDIATELY.

5.90.349_EN (0119)