CommercialAdministrativeMedium impact
Updated Evernorth Behavioral Health Administrative Guidelines now available
Cigna·CA, CO, FL, IL, IN, MA, MI, NJ, RI, TX, VA, WI · Psychiatry·Coverage
Effective date
Aug 22, 2025
We identified it
Jun 18, 2026
Summary
Evernorth has updated their Behavioral Health Administrative Guidelines with changes to appointment access standards, Risk Adjustment Program documentation, case management processes, and state-specific requirements across multiple states. The guidelines include program requirements, policies, and procedures for providing behavioral health services to patients with Evernorth or Cigna Healthcare coverage.
Action Required
By August 22, 2025: Behavioral health providers must review updated Evernorth Administrative Guidelines focusing on clarified appointment access standards, Risk Adjustment Program requirements, and updated utilization management processes for prior authorization requests. Ensure clinical information is submitted with all prior authorization requests before peer-to-peer and appeal reviews. Providers in affected states must comply with updated state-specific addenda requirements including new appointment wait time standards.