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Behavioral health clinical practice guidelines
Cigna·Psychiatry, Family Medicine, Internal Medicine +1 more·Medical Policy
Effective date
Nov 14, 2024
We identified it
Jun 19, 2026
Summary
Evernorth Behavioral Health has updated their clinical practice guidelines for behavioral health services, clarifying which evidence-based guidelines they use for prior authorization decisions and medical necessity determinations. The policy emphasizes adherence to APA, ASAM, and MCG guidelines for behavioral health treatment authorization.
Action Required
Immediately: Billing team should review current behavioral health prior authorization processes to ensure alignment with updated Evernorth guidelines. Verify that documentation for behavioral health services references APA, ASAM Criteria, MCG Behavioral Health Guidelines, and LOCUS/CALOCUS-CASII standards when submitting prior authorization requests. Access the Evernorth Provider website for current medical necessity criteria.