Cigna Evernorth BH Denial Recovery — 2026 Playbook

Cigna’s Evernorth Health Services division manages BH for Cigna commercial + Cigna Medicare Advantage. Historically less aggressive than Optum/Aetna on downcoding but strict on medical necessity for residential/IOP.

Common Cigna/Evernorth BH Denials 2026

1. Medical necessity denials on continued residential
2. PA required for 97155 ABA supervision (payer-specific)
3. IOP visit-cap denials at week 6-8
4. Concurrent BH + medical E/M billing conflicts

Cigna Appeal Framework

CignaforHCP portal appeal → peer-to-peer within 72 hours → MHPAEA parity complaint if pattern.

MHPAEA Parity Appeals · Free audit

– KD, Revenant Care