How to appeal a prior authorization denial from Cigna
Cigna prior-authorization denials usually stem from missing clinical criteria under MCG or eviCore guidelines. Reading the exact criteria set on your denial is the single most important step.
Step-by-step
- 1
Identify the criteria set
Cigna delegates many prior auths to eviCore (radiology, oncology, cardiology). Your denial names the criteria document used - request it in writing.
- 2
Request a peer-to-peer immediately
Peer-to-peers are free, fast, and frequently overturn the original decision when your physician explains the clinical picture. Schedule within the deadline on the denial.
- 3
Submit a written appeal if the peer-to-peer fails
Include: denial, criteria set, letter of medical necessity mapped to each criterion, and chart notes. Send via certified mail or the Cigna provider portal.
- 4
Request external review
After the final internal denial, you have 60 days to request an Independent Review Organization.
Documents to gather
- Cigna denial letter and prior auth determination
- eviCore or MCG criteria cited
- Letter of medical necessity mapped to each criterion
- Full chart notes and imaging
Decode your full denial letter
Paste or upload your Cigna letter and get the exact deadline, escalation ladder, and a ready-to-send appeal letter.
Decode my letterFrequently asked questions
- How fast can a peer-to-peer happen?
- Often within 24 - 72 hours of request. For urgent care needs, Cigna must offer an expedited peer-to-peer within 24 hours.
- Can I appeal before the service?
- Yes - pre-service appeals are common and run on the same 180-day window. Doing this before incurring costs is almost always better than after.