Skip to content

INSURER FILING GUIDE

Cigna Healthcare, including Evernorth behavioral

Use this public information to prepare your packet, then confirm the route on the insurer's own page.

Get the skill

AT A GLANCE

Claim facts

Member form

Member Claim Form

Number: 803392f

Revision: Rev. 03/2023

Open the insurer form
Portal uploadNot published by the insurer
Portal pathGeneric page: Claims and Accounts > Submit a Claim Online; exact behavioral upload path Not published by the insurer and signed-in page UNREADABLE
Mail addressPLAN-DEPENDENT: Send your completed claim form and itemized bills to the Cigna address listed on your ID card. | MH: PLAN-DEPENDENT: HMO or POS: Cigna Behavioral Health, Inc., Attn: Claims Service Dept., P.O. Box 188022, Chattanooga, TN 37422; Open Access Plus: the Cigna address listed on your identification card.
FaxNot published by the insurer
AttachmentsEmployee name; patient name; provider name and credentials; provider address; provider tax ID; date of service; ICD-10 diagnosis code; type of service or procedure code; charge for service; primary carrier EOB when applicable
Deadline180 days from date of service unless the plan or state law allows more time
Outcome and statusMyCigna to view and manage claims; EOB after processing
Processing timeNot published by the insurer
CaveatsMarketplace plans may require in-network care; employer carve-outs and benefit terms control; Medicare Advantage and Medicaid are excluded

STEP BY STEP

Filing steps

Source: https://www.cigna.com/static/www-cigna-com/docs/cbh-member-claim-form.pdf

Read date: 10-09-2026

Research steps

  1. Use the dedicated 803392f Member Claim Form for behavioral claims. It applies to all behavioral plans when the provider is not filing. https://www.cigna.com/static/www-cigna-com/docs/cbh-member-claim-form.pdf
  2. Complete the employee section, applicable patient, accident, and other-coverage sections, and the member certification. Leave Payment Instructions unsigned for member payment from an out-of-network provider. https://www.cigna.com/static/www-cigna-com/docs/cbh-member-claim-form.pdf
  3. Attach an itemized bill carrying employee and patient names, provider name and credentials, provider address and tax ID, date, ICD-10 diagnosis, procedure or service code, and charge. https://www.cigna.com/static/www-cigna-com/docs/cbh-member-claim-form.pdf
  4. Add the primary carrier EOB when Cigna is secondary. https://www.cigna.com/static/www-cigna-com/docs/cbh-member-claim-form.pdf
  5. NOT PUBLISHED: an exact behavioral upload path. The generic myCigna page advertises online claim submission, but the behavioral instructions publish paper submission. https://www.cigna.com/individuals-families/member-guide/claims-and-eobs
  6. NOT PUBLISHED: accepted file types, size limit, file count, document-combination rule, and confirmation.
  7. Check the processed claim and EOB in myCigna. https://www.cigna.com/individuals-families/member-guide

Filing facts

  • Portal upload: NOT PUBLISHED
  • Portal: myCigna
  • Portal path: Generic page: Claims and Accounts > Submit a Claim Online; exact behavioral upload path NOT PUBLISHED and signed-in page UNREADABLE
  • Mail address: PLAN-DEPENDENT: Send your completed claim form and itemized bills to the Cigna address listed on your ID card. | MH: PLAN-DEPENDENT: HMO or POS: Cigna Behavioral Health, Inc., Attn: Claims Service Dept., P.O. Box 188022, Chattanooga, TN 37422; Open Access Plus: the Cigna address listed on your identification card.
  • Fax: NOT PUBLISHED
  • Attach: employee name; patient name; provider name and credentials; provider address; provider tax ID; date of service; ICD-10 diagnosis code; type of service or procedure code; charge for service; primary carrier EOB when applicable
  • File types: NOT PUBLISHED
  • File size limit: NOT PUBLISHED
  • Maximum files: NOT PUBLISHED
  • One file or separate files: NOT PUBLISHED
  • Confirmation: NOT PUBLISHED
  • Status check: myCigna to view and manage claims; EOB after processing
  • Processing time: NOT PUBLISHED
  • Member deadline: 180 days from date of service unless the plan or state law allows more time
  • Deadline basis: YES: plan or state law may allow more time
  • Mental health route: Use the dedicated Evernorth Behavioral Health Member Claim Form; public behavioral instructions publish paper submission, while generic myCigna advertises online claim submission

Confirm the address, fax number or portal path on the insurer's own claims page before you send; read on 10-09-2026.

Read on 10-09-2026 from https://www.cigna.com/static/www-cigna-com/docs/cbh-member-claim-form.pdf;https://www.cigna.com/static/www-cigna-com/docs/form-medical-claim.pdf. Confirm the address, fax number or portal path on the insurer's own claims page before you send.