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Tier 2 & 3 Providers

Click here for Pre-Treatment Review/Pre-Certification for Cigna OAP and Out-of-Network providers? (Tier 2 and Tier 3 providers)
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Inpatient Admission Prior Authorization Request Standard Outpatient Prior Authorization Request Bariatric Surgery Prior Authorization Request
Cancer Prior Authorization Request Cigna LifeSource Programs of Excellence Cigna Medical Policy Resources Documents
Dialysis Prior Authorization Request DME Prior Authorization Request Home Delivery Medical Supplies
Home Health Prior Authorization Request Infusion Services Prior Authorization Request Ongoing Therapy Prior Authorization Request
Organ and Tissue Prior Authorization Request Spinal Surgery Prior Authorization Request Verification of Benefits
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Each plan administered by Allegiance Benefit Plan Mangement, Inc. (Allegiance), a third party administrator, contains benefit exclusions and limitation. Both Allegiance and these plans comply with all applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability, or sex.

Language Access Services: The information above is a requirement of Section 1557 of the Affordable Care Act effective August 18, 2016. It is required to assist those who may need assistance with the English language or translation assistance to a different language in which they are more fluent.

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Please choose the correct plan design you are enrolled in (or are enrolling for) to search for an applicable providers

Premier Consumer Plan – Narrow network, high deductible plan design

Premier EPO Plan – Narrow network, standard deductible plan design, office visit copays

Consumer Plan - Triple Tier network, high deductible plan design

Choice Plan – Triple Tier network, standard deductible plan design, office visit copays

Out of Area Plan NOTE: You must reside outside of the defined service area to be eligible for this plan

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