Effective January 1, 2026, Cigna Healthcare Medicare Advantage rebranded as HealthSpring (now owned by HCSC). Prior authorizations for post-acute care services moved from EviCore to the HealthSpring clinical team. Submit via Availity Essentials under payer name "HealthSpring Medicare Advantage," payer ID 52192. DME prior authorizations followed on March 1, 2026. Existing EviCore approvals remain valid through their expiration date.
Why Cigna Medicare Advantage Is Now HealthSpring
On January 1, 2026, Cigna Healthcare Medicare Advantage completed its transition to HealthSpring, a name now owned and operated by Health Care Service Corporation (HCSC). The rebrand is more than cosmetic — it came with concrete changes to how prior authorizations are submitted, reviewed, and appealed for Medicare Advantage members.
For independent practices, the name change alone created confusion. Prior authorizations that previously went to EviCore (Cigna's managed care subsidiary) for post-acute care services now route through the HealthSpring clinical team. Providers still using EviCore or the old "Cigna Medicare Advantage" payer space in Availity may be submitting requests that never reach the right reviewer.
Stale Payer Space Will Break Your PA
If you are submitting Medicare Advantage PAC or DME prior authorizations to EviCore or to the Cigna Medicare Advantage payer space in Availity for dates of service on or after January 1, 2026, those requests are not routing correctly. Update your Availity submission to the HealthSpring Medicare Advantage payer space (payer ID 52192).
What Changed for Prior Authorization in 2026
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Three specific prior authorization changes took effect with the HealthSpring transition. The table below maps each service category to the old process, the new process, and the effective date.
| Service Category | Previous Process | New Process (2026) | Effective Date |
|---|---|---|---|
| Post-Acute Care (SNF, IRF, LTAC, Home Health) | EviCore via Cigna Medicare payer space | HealthSpring clinical team via Availity (payer ID 52192) | January 1, 2026 |
| Durable Medical Equipment (DME) + Orthotics/Prosthetics | EviCore | HealthSpring clinical team via Availity (payer ID 52192) | March 1, 2026 |
| Commercial Cigna PA (non-Medicare) | CoverMyMeds / Availity (Cigna payer space) | No change — Cigna commercial PA process unchanged | N/A |
| Existing EviCore approvals (pre-Jan 1) | EviCore issued | Remain valid through expiration — no resubmission needed | Ongoing |
The commercial Cigna prior authorization process (CoverMyMeds, Cigna's Availity payer space) is not affected by the HealthSpring transition. Only Medicare Advantage members are impacted.
Post-Acute Care (PAC) Prior Authorizations: What Changed January 1, 2026
The largest operational shift is in post-acute care. Beginning January 1, 2026, HealthSpring's own Clinical Review Services department manages prior authorizations for:
- Skilled Nursing Facility (SNF) placements
- Inpatient Rehabilitation Facility (IRF) admissions
- Long-Term Acute Care (LTAC) placements
- Home Health (HH) services
How to Submit PAC Prior Authorizations to HealthSpring
- Log in to Availity Essentials at availity.com
- Select payer: HealthSpring Medicare Advantage (payer ID 52192)
- Submit the prior authorization request through the HealthSpring payer space — not the Cigna Medicare payer space, and not EviCore
- Include the requesting facility name and NPI and the servicing facility name and NPI — CMS guidelines require both
- Attach pertinent clinical information at the time of submission; HealthSpring may follow up if it needs additional documentation
Concurrent Reviews for SNF and IRF
For ongoing inpatient PAC stays, facilities submit concurrent review requests to HealthSpring at least two days before the current prior authorization end date. This replaces the previous EviCore concurrent review workflow.
Out-of-Network Facilities
Prior authorization requests for out-of-network facilities are reviewed by a HealthSpring medical director. Build extra lead time into your submission if the member will be discharged to an out-of-network PAC facility.
DME Prior Authorizations: What Changed March 1, 2026
Effective March 1, 2026, HealthSpring took over prior authorization management for durable medical equipment (DME), orthotics, and prosthetics. EviCore handled DME authorizations through February 28, 2026.
For dates of service before March 1, 2026: Submit to EviCore as usual.
For dates of service on or after March 1, 2026: Submit to HealthSpring via Availity Essentials (payer ID 52192).
EviCore approvals for DME that were issued before the transition remain valid through their expiration date. You do not need to resubmit for approvals already obtained.
A complete list of DME and orthotic/prosthetic codes requiring prior authorization is available at HealthSpring.com/Providers under Working With Us → Forms. HealthSpring updates this code list quarterly to reflect CPT and HCPCS changes. For Cigna-specific appeal and timely filing deadlines that apply to HealthSpring Medicare Advantage members, see the Cigna timely filing limits guide.
How to Submit Prior Authorization to HealthSpring
The steps below apply to both PAC and DME prior authorization requests submitted under HealthSpring Medicare Advantage as of 2026.
Preferred method: Availity Essentials (portal)
- Log in at availity.com
- Select the HealthSpring Medicare Advantage payer space
- Navigate to the prior authorization workflow
- Complete the form in full — incomplete forms slow review
- Attach clinical documentation at time of submission
- Note the authorization reference number for your records
Fax and mail: Instructions are available in the HealthSpring Provider Manual at HealthSpring.com/Providers. Fax remains an option but Availity provides faster tracking and confirmation.
PA Is Not a Payment Guarantee
A HealthSpring prior authorization approval confirms medical necessity review. It is not a guarantee of claims payment. Eligibility, benefits, and billing codes still need to be verified separately before the claim is submitted.
PA Response Times: New 7-Day Rule in 2026
Effective January 1, 2026, HealthSpring aligned its prior authorization response times with current CMS Medicare Advantage guidelines:
| Request Type | Response Time (2026) | Previous Timeline | Extension Option |
|---|---|---|---|
| Nonurgent preservice PA | Up to 7 calendar days | Up to 14 calendar days | Up to 14 additional days if extension requested |
| Concurrent review (inpatient stay) | Up to 7 calendar days | Up to 14 calendar days | Up to 14 additional days if extension requested |
| Urgent/expedited PA | Up to 72 hours | Up to 72 hours (unchanged) | Up to 14 additional days if needed |
If HealthSpring extends a decision timeline, it is required to send a notification letter to both the provider and the affected member explaining the delay.
This change brings HealthSpring in line with CMS Interoperability and Prior Authorization Rule requirements, which apply across Medicare Advantage plans.
What Happens If HealthSpring Denies Your Prior Authorization
A HealthSpring prior authorization denial triggers the Medicare Advantage appeal process. Providers can appeal a denial of a service not yet provided on behalf of a member — but the member must be aware and must authorize the provider to act on their behalf via an Appointment of Representative Form.
Appeal Steps for HealthSpring PA Denials
- Review the denial notice. It will specify the reason for denial and include appeal instructions. Clinical criteria cited in the denial — typically from HealthSpring's own clinical review standards — are the target for your rebuttal.
- Request a peer-to-peer review. Contact HealthSpring to schedule a call between your physician and the HealthSpring medical director who reviewed the case. This is often the fastest path to overturn for medical necessity denials.
- File a formal appeal. Submit the postservice appeal and claim dispute form through the HealthSpring provider website. Attach medical records and supporting clinical documentation. Submit by fax or mail per the form instructions.
- Contact HealthSpring provider services at 800-511-6943 for questions about appeal status or dispute process.
- Request external review if the internal appeal is exhausted. Medicare Advantage members have access to an independent review through the Qualified Independent Contractor (QIC) process under CMS rules.
For prior authorization denials involving Medicare Advantage members, the CMS Medicare Advantage appeal framework sets the deadlines. Expedited reconsiderations must be resolved within 72 hours; standard reconsiderations within 30 days. For appeal letter templates specific to Cigna, see the Cigna appeal letter template.
If you're managing a high volume of HealthSpring PA denials across multiple Medicare Advantage patients, tracking denial reasons and appeal outcomes systematically reduces the rework on each case. Muni Appeals helps billing teams organize appeal documentation, track deadlines, and build payer-specific templates for HealthSpring and other Medicare Advantage plans.
How to Tell If a Member Has HealthSpring vs. Commercial Cigna Coverage
The plan name on the member's insurance card is the clearest indicator. As of January 1, 2026, Medicare Advantage members who were previously on "Cigna Healthcare Medicare Advantage" plans now carry HealthSpring coverage. Commercial Cigna plans (employer-sponsored, ACA marketplace) are not affected and continue to use the standard Cigna PA process via CoverMyMeds and the Cigna Availity payer space.
If you are unsure about a member's current plan routing, eligibility verification through Availity will show the active payer space. Running eligibility before submitting a PA request prevents misrouted submissions.
Frequently Asked Questions
Is Cigna Medicare Advantage the same as HealthSpring in 2026?
Yes. Cigna Healthcare Medicare Advantage rebranded as HealthSpring effective January 1, 2026, following the sale to Health Care Service Corporation (HCSC). Members on Cigna Medicare Advantage plans are now HealthSpring members. The coverage and benefits were not eliminated — the administrative operations, including prior authorization management, transitioned to HealthSpring.
What Availity payer ID do I use for HealthSpring prior authorizations?
Use payer ID 52192 when submitting prior authorization requests for HealthSpring Medicare Advantage members in Availity Essentials. Select the payer space named "HealthSpring Medicare Advantage" — not the Cigna Medicare payer space, which is no longer the correct routing for these members.
Do I need to resubmit prior authorizations that EviCore already approved?
No. Prior authorizations approved by EviCore (or Cigna Medicare) before the transition remain valid through their stated expiration date. You do not need to request a new approval. When those authorizations expire, any renewal or new authorization for a date of service after the transition date must be submitted to HealthSpring.
Where do I get the HealthSpring prior authorization form?
Go to HealthSpring.com/Providers → Working With Us → Forms. Prior authorization forms and the current list of codes requiring PA are available there. HealthSpring updates the PA code list quarterly to reflect CPT and HCPCS changes.
What services require prior authorization under HealthSpring Medicare Advantage?
As of Q1 2026, services requiring prior authorization include post-acute care (SNF, IRF, LTAC, home health), durable medical equipment, orthotics and prosthetics, and select specialty services listed in the HealthSpring Q1 2026 Prior Authorization List. The full list is available at the HealthSpring provider website and is updated quarterly.
What is the appeal phone number for HealthSpring PA denials?
For questions about appeals and claim disputes, contact HealthSpring provider services at 800-511-6943. Appeal instructions are also provided in the denial notice and in the HealthSpring Provider Manual at HealthSpring.com/Providers.
How does the HealthSpring transition affect my Cigna commercial plan prior authorizations?
It does not. Commercial Cigna plans (employer-sponsored, ACA marketplace, Cigna Medicaid) continue to use the CoverMyMeds portal or Availity under the Cigna payer space for prior authorizations. The HealthSpring transition applies only to Medicare Advantage. See the Cigna prior authorization guide for 2026 for full commercial PA instructions.
What is the difference between HealthSpring and Cigna PromptPA?
HealthSpring is the rebranded name for Cigna Medicare Advantage plans. Cigna PromptPA was the prior authorization portal for commercial and Medicare Advantage plans — it has been retired and replaced by CoverMyMeds for commercial plans. HealthSpring Medicare Advantage PA submissions now go through Availity Essentials (payer ID 52192), not PromptPA or CoverMyMeds. See the Cigna PromptPA guide for more on the PromptPA retirement.
Ready to Handle HealthSpring PA Denials More Efficiently?
Prior authorization denials from HealthSpring — especially for post-acute care — often require clinical documentation, peer-to-peer outreach, and appeal submissions within tight CMS deadlines. For independent practices billing Medicare Advantage with high PAC or DME volume, managing this manually across multiple patients becomes a documentation burden.
Get Started:
- Organize appeal documentation and deadlines by payer and plan type
- Build reusable templates for HealthSpring PA denial rebuttal letters
- Track concurrent review deadlines for inpatient PAC stays
- Manage Appointment of Representative Forms for Medicare Advantage appeals
This guide reflects HealthSpring Medicare Advantage prior authorization procedures as of Q1 2026, including the January 1, 2026 PAC transition and March 1, 2026 DME transition from EviCore. Prior authorization requirements are updated quarterly by HealthSpring. Commercial Cigna prior authorization processes are not affected by this transition. Always verify current PA requirements at HealthSpring.com/Providers before submission.