Evernorth
Overview
Cigna’s behavioral-health network. Normally receives behavioral-health referrals from Cigna, but contract terms vary by customer — sometimes behavioral-health providers are negotiated inside the Cigna contract directly, which creates routing ambiguity.
Pain Points / Open Issues
- New Jersey license requirement: Evernorth requires LBA (Licensed Behavior Analyst) in NJ — BCBA certification alone is NOT sufficient. Example: Sahana Padmanabhan’s NJ enrollment was denied: “provider application was denied due to provider not having a valid license for the state of New Jersey, valid license type is LBA and provider has BCBA.” Paige flagged this in October 2025 and put the line on hold.
- Cross-payer verification discrepancy: other payers (Horizon, Optum) have processed claims for Sahana despite her lacking the NJ license — suggests out-of-network payments or verification gaps at those payers; worth investigating further.
- 3 on-hold Arizona lines remain open pending audit of Evernorth/Cigna situation (as of 2026-04-16).
Key Facts
- NJ behavior-analyst licensing: requires LBA specifically (not BCBA).
- Behavioral-health routing from Cigna depends on whether the contract was negotiated with Cigna directly or separately with Evernorth.
Related Customers
Source History
- 2026-04-16 — A