For information on how to submit a preauthorization for frequently requested services/procedures for your patients with Humana follow the links below.
Tag: Precertification
Aetna Changes in NPL
Changes in National Precertification List
As of August 1, 2025, we require precertification for the following:
- Conexxence (denosumab-bnht, J3490, J3590, C9399)
- Bomyntra (denosumab-bnht, J3490, J3590, C9399)
- denosumab-bnht (biosimaliar Prolia, J3490, J3590, C9399)
- denosumab-bnht (biosimaliar Xgeva, J3490, J3590, C9399)
- Omlyclo (omalizumab-igec, J3490, J3590, C9399) (precertification includes the site of care)
- penpulimab-kcqx (J3490, J3590, C9399) (precertification includes the site of care)
- ustekinumab-stba (J3490, J3590, C9399)
- ustekinumab (J3490, J3590, C9399)
- Starjemza (ustekinumab-hmny, J3490, J3590, C9399)
Submitting precertification requests:
Submit precertification requests at least two weeks in advance and include the actual date of service in the request. To save time, request precertification online through our provider portal on Availity.* Doing so is fast, secure and simple.
You can also use your practice’s Electronic Medical Record (EMR) system if it’s set up for electronic precertification requests. Use our “Search by CPT® code” function on our Precertification Lists page to find out if the code requires precertification.***
If you need precertification for a specialty drug for a commercial or Medicare member, submit your request through Novologix®, which is also available on Availity®.
Note to Texas providers: Changes described in this article will be implemented for fully insured plans written in the state of Texas only if such changes are in accordance with applicable regulatory requirements. Changes for all other plans will be as outlined in this article.
Cigna Commercial REMOVING Multiple Services from Their Pre-Cert List.
Many services will no longer require prior authorization (i.e. Precertification) for Cigna Commercial, beginning May 31, 2025.
Please note, however, that removal from precertification is not a guarantee of payment. Codes may be subject to standard code editing, benefit plan exclusions, and post-service review for coverage.
Aetna on Pre-certs
Submitting Precertification Request
Be sure to submit precertification requests at least two weeks in advance. To save time, request precertification online. Doing so is fast, secure and simple.
You can submit most requests online through our Availity provider portal.* Or you can use your practice’s Electronic Medical Record (EMR) system if it’s set up for electronic precertification requests. Use our “Search by CPT® code” search function on our precertification lists page to find out if the code requires precertification.**
Be Sure and Click the links for more information
The First Quarter 2022 issue of Cigna Network News is now available
Check out these pages:
4. Preventive Care Services Policy Updates
5. Reimbursement Policy Updates
7. Precert Updates (click here to view the Master Precert List)
8. Webinar Schedule for staff training.
18. 2022 Cigna MA plan highlights (and card sample)
25. How to use Z Codes
34. How to contact Cigna
Aetna OfficeLink Updates 6/1/2021
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Step Therapy Requirement
Cigna Medicare Advantatge
The goal of step therapy is to help achieve lower drug prices while maintaining access to drugs for patients.
Certain Part B drugs that currently require precertification will also require step therapy.
The list of drugs that require step therapy can change throughout the plan year.
Cigna MA
Cigna Updates
Cigna is pleased to announce we are expanding our Musculoskeletal and Pain Management Program to include select Cigna Medicare Advantage customers.
Beginning June 1, 2021, precertification requests for affected services, including major joint surgery services related to the hip, knee, and shoulder and interventional pain management procedures must be submitted to eviCore instead of Cigna.
CIGNA MEDICARE ADVANTAGE PRIOR AUTHORIZATION PROGRAM – ORIENTATION SESSION SCHEDULE.
Cigna Medicare Advantage has partnered with eviCore healthcare to provide patients with access to high quality, medically appropriate care that is consistent with evidence-based treatment guidelines.
The following procedures will require prior authorization for patients covered by Cigna Medicare Advantage
- Major Joint Services (Hip, Knee, Shoulder)
- Interventional Pain Management Procedures
eviCore healthcare will be leading online orientation sessions designed to assist you and your staff with the new program. For times and how to register click here.
Step Therapy Required for Part B Drugs and Biologics, Revised 2/24/21
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