Cigna has removed prior authorization requirements for 600 diagnostic codes, streamlining processes for members and providers. This step, covering a quarter of previously mandated codes, builds on years of efforts to ease prior authorization barriers. Less than 4% of services will now require prior authorization for most members, promoting patient safety and affordability. Cigna also plans to eliminate prior authorization for 500 codes in Medicare Advantage, while discussions continue regarding reforming these requirements for improved healthcare delivery.
Cigna has taken significant steps to enhance the healthcare experience for both its members and providers by eliminating the need for prior authorization across 600 diagnostic codes. This strategic move aims to simplify processes and reduce hurdles.
The elimination of prior authorization will encompass approximately a quarter of the codes that currently mandate this requirement, according to Cigna’s official statement. This initiative builds upon years of dedicated effort to alleviate obstacles related to prior authorization. Since 2020, Cigna has already removed prior authorization requirements from around 1,100 codes.
As a result of this recent update, less than 4% of services will now require prior authorization for most of Cigna’s members, the company stated.
Dr. David Brailer, Executive Vice President and Chief Health Officer of The Cigna Group, expressed the significance of this development, saying, “We aim to enhance patient safety, elevate health outcomes, and promote affordability in healthcare. This crucial step will enable us to achieve these goals while also simplifying administrative complexities within the healthcare system.”
Dr. Brailer added, “In response to feedback from our healthcare partners, we have thoughtfully implemented these changes. We remain committed to the success of this vital endeavor and anticipate continued progress in the future.”
Cigna also disclosed plans to eliminate prior authorization for 500 codes within its Medicare Advantage program.
Healthcare providers have long highlighted the burdensome nature of prior authorization procedures, which often result in extended waiting times for patients and contribute to administrative fatigue. On the other hand, payers argue that prior authorization and similar utilization management tools play a pivotal role in ensuring that patients receive appropriate care when it is most needed.
Amid ongoing discussions regarding the reform of prior authorization requisites, the Centers for Medicare & Medicaid Services are exploring the adoption of electronic prior authorization, which promises faster approval processes.
Dr. Scott Josephs, Chief Medical Officer at Cigna Healthcare, acknowledged the importance of prior authorizations in upholding patient safety and affordability. He stated, “While clinicians and health plans recognize the significance of prior authorizations for patient safety and cost-effectiveness, both parties agree that further efforts can be made to reduce the administrative burden on clinicians. We will persist in collaborating with clinicians to align care delivery objectives and outcomes, continuously evaluating the potential for additional improvements without compromising patient safety.”
