Precertification

Confirm if your care will be covered before you have a procedure or treatment. To help you determine if the services you receive are a covered benefit, Cigna precertifies certain services.

How It Works

Precertification of benefits: Wondering if a procedure or treatment will be covered? Ask your physician to request a precertification of benefits to confirm eligibility, covered services, benefits and any limits. To start the process, your physician should contact Cigna at 800-247-4433 in advance of the procedure, treatment or services. Note: A precertification that a procedure or services may be covered under the Parkland Employee Health Plan (PEHP) does not guarantee that the PEHP will ultimately pay the claim.
Prior authorization: Before having certain treatments, procedures or surgeries, your physician must request prior authorization. If prior authorization is not obtained, your claim could be denied.
Hospital preadmission certification: Requests for non-emergency hospital stays (other than a maternity stay) must be approved in advance. Precertification is not required for a maternity stay of 48 hours for vaginal deliveries or 96 hours for cesarean sections.
Continued stay review: In order to stay in the hospital beyond the number of days approved during the precertification process, your hospital stay will be subject to a continued stay review by the medical plan administrator.
Case management: This service is designed to help guide your care if your medical condition puts you at risk for medical complications, or if you need rehabilitation or additional health care support. The program strives to balance quality and cost-effective care while maximizing your quality of life.

Important Fact About Tier 3 Providers!

Your doctor will coordinate precertification if you see a Tier 1 or Tier 2 provider. If you see a Tier 3 provider, you are responsible for obtaining approval for a hospital admission. If you don’t use the precertification or continued stay review programs when you are hospitalized, you may pay a penalty or have a reduction in benefits.

Specialized Support

Cigna nurses will guide you every step of the way.

Monitor your case from prior authorization through discharge.

Provide clinical oversight and coordinate with the facility.

Follow evidence-based guidelines to determine the appropriate level of care and treatment.

Get Started

Precertification of benefits and prior authorization — Have your physician contact Cigna at 800-247-4433 in advance of the procedure or treatment.
Continued stay review — Cigna nurses will coordinate this process.
Case management — Cigna will contact you by mail and/or phone if this service can help.