Cigna timely filing limit, appeals and provider manual guide
Cigna Healthcare publishes its commercial filing limit: 90 days after the date of service for participating providers and 180 days for out-of-network claims. A written payment appeal is due within 180 calendar days of the payment or denial notice. Cigna Medicare Advantage runs on a separate in-network manual with its own clocks.
Written by Salman Saeed, CEO and Co-Founder · Reviewed by a Certified Medical Coder · Last reviewed October 2026In short: Cigna's commercial limit is 90 days from the date of service for participating providers and 180 days out of network, counted from the last date of service on consecutive-day stays. A written appeal is due within 180 calendar days of the payment or denial notice. Medicare Advantage claims follow the in-network manual and your agreement.
Cigna filing, prior authorization and portal
Appeal levels
Top denials from Cigna
| Code | Meaning | Our fix |
|---|---|---|
| CO-29 | The time limit for filing has expired | Call customer service for a real-time adjustment, or appeal with evidence of extraordinary circumstances. You cannot balance bill the patient. |
| CO-197 | Precertification, authorization or notification absent | Cigna routes precertification not obtained to a health care provider appeal. Check the Master Precertification List before the service. |
| CO-16 | Claim lacks information or has submission or billing errors | Send the missing data on a clean claim; supporting documents can be noted in box 19 of the electronic claim. |
| CO-22 | This care may be covered by another payer per coordination of benefits | Bill the primary first; Cigna counts the clock from the primary EOB processing date. |
| CO-50 | Not deemed a medical necessity by the payer | Cigna lists medical necessity denials as appealable by the provider or the customer; attach records to the written appeal. |
What are Cigna's filing and appeal deadlines at a glance?
The figures below come from Cigna's provider web pages for commercial plans and from the June 2025 Cigna Healthcare Medicare Advantage In-Network Provider Manual. Cigna says that if its reference guide conflicts with your health care provider agreement or applicable law, the agreement or the law supersedes the guide.
| Question | What Cigna's documents say | Product |
|---|---|---|
| Filing limit, participating | 3 months [90 days] after the date of service | Commercial, Cigna web pages |
| Filing limit, out of network | 6 months [180 days] after the date of service | Commercial, Cigna web pages |
| Consecutive-day services | Counted from the last date of service | Commercial |
| Written appeal | Within 180 calendar days of the initial payment or denial notice, or of the last payment adjustment | Commercial |
| Appeal review | Completed in 60 days; decision notice within 75 business days of receipt | Commercial |
| Arbitration request | Within one year of the letter communicating the final internal decision | Commercial |
| Claim reconsideration | Up to 180 days from the claim payment date | Medicare Advantage in-network manual |
| Provider appeal | Within 65 days of the original decision unless your agreement says otherwise; one level | Medicare Advantage in-network manual |
What is the Cigna timely filing limit and what are the exceptions?
Cigna's claims page tells participating providers to submit within 90 days after the date of service and out-of-network providers within 180 days. Its When to File policy words the same limits as three months [90 days] and six months [180 days], applies to claims submitted directly to Cigna, and carries an April 1, 2015 revision date, so check your contract for newer terms.
The listed exceptions are a longer period required by applicable law, extra time your provider agreement allows, and coordination of benefits (COB), where the clock runs from the processing date on the primary carrier's EOB or explanation of payment. If Medicare is the secondary payer, the initial claim must reach the primary payer within Cigna's filing period. Cigna may also ask for evidence of extraordinary circumstances, such as a natural disaster.
If a claim was filed on time and Cigna asked for more information, the original timing holds. If you resubmit on your own and the resubmission is not an appeal, the filing limit applies. Your contract prohibits balance billing the patient for a claim denied as untimely. For how this compares across payers see our timely filing rule and the calculator.
For Medicare Advantage in-network claims, the manual says you agreed to submit claims within the time frames in your provider agreement. Its Florida custodial care section for Dual Eligible Special Needs Plan members says claims can be submitted within 180 days from the initial date of service and also to follow your contract or manual time frames.
Which portal or clearinghouse do I use to submit claims and check status with Cigna?
Cigna tells commercial providers to work with their EDI vendor for electronic claims and to use the Cigna for Health Care Professionals portal (CignaforHCP.com) for claim status and reconsiderations. Cigna's commercial claims page directs you to your EDI vendor for electronic submission, so take the payer ID from your vendor or the member's card.
For Medicare Advantage in-network claims the manual gives electronic payer ID 62308, a paper claims address of PO Box 981706, El Paso, TX 79998, and 800.230.6138 for claims questions. It asks you to verify eligibility in Availity Essentials. Supporting documents on a commercial claim can go in box 19 of the electronic claim or attach to a paper claim without delaying processing.
Does a corrected claim or an appeal change the Cigna filing deadline?
No. Cigna's Medicare Advantage manual says timely filing requirements are not affected or changed by the appeal process or its outcome, and that if an appeal approves payment contingent on a corrected claim, the time frame is not automatically extended.
On the commercial side the same logic shows up in the resubmission rule above: a resubmission that Cigna did not request and that is not an appeal is held to the limit. Fix the claim inside the window instead of relying on an appeal to reopen it. Cigna's commercial pages describe no frequency-code step, so follow your clearinghouse's replacement-claim setup.
How does a Cigna commercial payment appeal work, step by step?
Call first, then file one written appeal, then arbitration if you still disagree. Cigna's appeals page says many timely filing, incomplete claim and fee schedule denials can be fixed by a real-time adjustment on the call, and that the written payment appeal is for what the call cannot resolve.
- Call 1 (800) 882-4462 and ask for a real-time adjustment.
- If the call fails, complete the Request for Health Care Provider Payment Review form, marking the reason for the appeal.
- Attach the original EOB, EOP or request letter and the documents that support overturning the decision, such as operative reports or medical records.
- Send it within 180 calendar days of the initial payment or denial notice, or of the last payment adjustment if Cigna adjusted the payment.
- Watch for the result: an overturn arrives as an explanation of payment with the reprocessed claim, and an upheld decision arrives as a letter that lists any further appeal rights.
| Scenario | Who appeals, per Cigna |
|---|---|
| Precertification denial for a service not yet rendered | Customer appeal |
| Precertification not obtained and services denied | Health care provider appeal |
| Claim reimbursement denial, including bundling, mutually exclusive, incidental and modifier denials | Health care provider appeal |
| Experimental or investigational, inpatient level of care or length of stay, medical necessity | Either |
| Benefit denials and maximum reimbursable amount | Customer appeal |
| Appeal type | Mail to |
|---|---|
| ID card shows GWH-Cigna or G | Cigna Healthcare Inc. National Appeals Unit, PO Box 188062, Chattanooga, TN 37422 |
| EviCore services | EviCore Claim Appeals, PO Box 5620, Hartford, CT 06102 |
| Express Scripts | Clinical Appeals Department, PO Box 66588, St. Louis, MO 63166-6588 |
| All other | Cigna Healthcare Inc. National Appeals Unit, PO Box 188011, Chattanooga, TN 37422 |
Arbitration must be requested in writing within one year of the final internal decision letter. If your agreement has no arbitration clause, Cigna describes a route through the AHLA ADR Service with an administrative fee, and the arbitrator's decision is binding. A termination appeal has a separate 30-calendar-day deadline from the termination notice. If you miss the review or arbitration dates, the last Cigna decision is final, and the customer cannot be billed for the denied amount because of your late request. Customer reviews can include an external review by an independent review organization, which the denial letter explains. California providers follow a separate Cigna dispute resolution policy.
How do I check eligibility and submit prior authorization for Cigna members?
For commercial plans, check the Master Precertification List, then request by EDI 278 through your practice management system, by phone at 1 (800) 882-4462, or by faxing the precertification intake form to 1 (866) 873-8279. Some services go through EviCore by Evernorth, such as durable medical equipment, home health, gastroenterology and certain musculoskeletal and oncology work.
Cigna says precertification is not required for emergency services, but an emergency that results in an inpatient hospital admission must be reported within one business day unless a state mandate says otherwise. The referring, ordering or admitting provider must obtain precertification for in-network services, and the rendering provider or facility must confirm approval before elective services. Not getting it may lead to a denial of payment.
For Medicare Advantage the manual says a standard request is decided within 14 calendar days and an expedited request within 72 hours, and notification of an inpatient or observation admission is due within 24 hours or the next business day. See our prior authorization and eligibility verification services.
What does Cigna's guidance mean for out-of-network claims?
Out-of-network claims get the longer 180-day filing window. For underpayment disputes under the No Surprises Act, the federal open negotiation and IDR clocks run separately from Cigna's appeal process and come from the regulations, not from Cigna's provider pages.
Our out-of-network billing and IDR service covers the dispute work, and the Medicare Advantage guide covers the separate Medicare product rules.
Where should I look next?
Read your Cigna agreement and the live pages before you rely on any single number. For other large payers see UnitedHealthcare and Aetna, or read about denial management.
- How to Submit Claims and When to File · Cigna Healthcare
- When to File (claim policies and procedures) · Cigna Healthcare
- Appeals and Disputes Policy and Procedures · Cigna Healthcare
- Precertification · Cigna Healthcare
- Cigna Healthcare Medicare Advantage In-Network Provider Manual, June 2025 · Cigna Healthcare
- X12 claim adjustment reason codes · X12
We check every rule, code and deadline against the official source. See our editorial policy.
Common questions
Straight answers from the team that does the work.
Ask a billing lead directly. A 20-minute call, Monday to Friday, 9am to 5pm Eastern.
01What is the Cigna timely filing limit for claims?
Cigna's commercial When to File page gives 90 days after the date of service for participating providers and 180 days for out-of-network claims, counted from the last date of service on consecutive-day stays. Exceptions cover longer legal periods, contract terms and COB. Medicare Advantage in-network claims follow the time frames in your provider agreement.
02What are the Cigna appeal levels and deadlines for a denied claim?
Commercial: one internal written appeal on the Request for Health Care Provider Payment Review form, due within 180 calendar days of the initial payment or denial notice, then arbitration within one year of the final decision letter. Medicare Advantage in-network: reconsideration up to 180 days from payment, and one appeal level within 65 days.
03How do I check eligibility and submit prior authorization for Cigna members?
Check the Master Precertification List, then request by EDI 278, by phone at 1 (800) 882-4462 or by faxing the intake form. Some services go through EviCore by Evernorth. Emergency services need no precertification, but an emergency admission must be reported within one business day unless state rules differ.
04What are the most common Cigna denial reasons for hospital and ER claims?
Cigna does not publish a ranked list, so we do not rank them. This page covers five CARCs that match processes in Cigna's pages: CO-29 for timely filing, CO-197 for precertification not obtained, CO-16 for incomplete claims, CO-22 for coordination of benefits and CO-50 for medical necessity, with the appeal path Cigna lists for each.
05How do I dispute an out-of-network underpayment from Cigna through open negotiation and IDR?
Start with a call to Cigna customer service at 1 (800) 882-4462, then a written appeal within 180 calendar days of the payment notice if the call does not fix it. The federal open negotiation and IDR deadlines under the No Surprises Act are separate and are explained on our No Surprises Act pages.
06Which portal or clearinghouse do I use to submit claims and check status with Cigna?
Commercial claims go through your EDI vendor, and claim status and reconsiderations are in the Cigna for Health Care Professionals portal at CignaforHCP.com. Medicare Advantage in-network claims use payer ID 62308, and eligibility is checked in Availity Essentials. Confirm the commercial payer ID with your EDI vendor.
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