How to Appeal a Cigna Denial: One Shot, Make It Count
The window is generous; the structure is not
Cigna matches Aetna and most BCBS plans with a 180-calendar-day window — the provider payment review must be initiated in writing within 180 days of the initial payment or denial decision (or of the last payment adjustment, where the dispute concerns an adjusted payment). Where Cigna differs is what happens after: it offers only one level of internal provider appeal, decided by a reviewer not involved in the original determination, with a review completed in 60 days and notification within 75 business days. Lose that, and what's left is alternate dispute resolution or arbitration under your provider agreement — generally requested within one year of the single-level denial letter.
Practical consequence: don't fire off a thin appeal early just because you have time. Use the runway to build one complete, well-cited submission — but calendar the deadline the day the denial arrives (150 days out is a sensible internal cutoff), because a missed deadline means no review of the merits at all. Get the exact date with our deadline checker.
Before you appeal: the two free shots
1. The informal resolution call. Cigna explicitly tries to resolve professional disputes informally at first contact — call the number on the member's ID card (or provider services, 800-882-4462) and ask the representative to review the adjudication. Straight processing errors often get corrected on the spot. Get a reference number regardless of outcome.
2. Peer-to-peer review. For clinical denials, Cigna's P2P process frequently resolves cases same-day — the treating physician discusses the case directly with the reviewing medical director. Request it promptly after the denial (within about 14 days for fastest scheduling). Critically, neither the informal call nor the P2P consumes your formal appeal rights — if they fail, the full 180-day window is still intact from the original denial date. There is no reason not to take both shots before spending your single internal appeal.
Routing: NAU or EviCore — read the denial letter first
There is no standard Cigna appeal form — Cigna requires a structured appeal letter. For most commercial denials it goes to the National Appeals Unit, P.O. Box 188011, Chattanooga, TN 37422, or by fax to the plan-specific number printed on your denial letter (there is no single Cigna appeal fax — using a stale number from an old claim is a classic way to file into the void; keep the fax confirmation receipt, because without it an unreceived appeal is treated as never filed).
The big routing trap: EviCore. Cigna delegates utilization review for imaging, cardiology, oncology, and musculoskeletal services to EviCore (an Evernorth company). If your denial letter lists EviCore as the reviewer, the appeal goes to EviCore Claim Appeals, P.O. Box 5620, Hartford, CT 06102 — and your argument should address EviCore's clinical criteria alongside Cigna's Medical Coverage Policy. An EviCore denial mailed to the general NAU sits in the wrong queue while your window runs.
Two 2026-specific notes: Cigna Medicare Advantage post-acute care services (SNF, IRF, LTAC, home health) are now managed by HealthSpring through Availity — confirm PAC appeal routing with provider services before submitting; and prior authorizations have moved from PromptPA to CoverMyMeds, which silently routes imaging/cardiology/oncology/MSK requests to EviCore — the PA confirmation tells you who the reviewing entity is, which tells you where any appeal goes.
Medical necessity: cite the Medical Coverage Policy, not general guidelines
Cigna reviewers evaluate medical necessity against Cigna Medical Coverage Policies — the company's equivalent of Aetna's CPBs and UHC's CDGs. An appeal citing general clinical guidelines without tying the argument to the specific Cigna policy governing the denied service is measurably weaker than one that names the policy number, quotes its criteria, and maps the patient's documented findings to each point. One structural note in your favor: in Cigna's process, a nurse reviewer can reverse a medical necessity denial but cannot uphold one — an appeal strong enough to satisfy the first clinical reviewer can win without ever reaching a physician reviewer, so make the criteria mapping impossible to miss.
Cigna deadlines at a glance
One appeal level means no room for a weak submission
Our denial team runs the informal call, the peer-to-peer, and the appeal letter with the right policy citations — routed to NAU or EviCore correctly the first time. See what your Cigna denials are costing you.
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