Cigna to remove 25% of medical services from prior authorization
The company has now removed prior authorization on more than 1,100 medical services since 2020.
Photo: Reza Estakhrian/Getty Images
Cigna Healthcare, the health benefits provider of the Cigna Group, will be removing close to 25% of medical services from prior authorization requirements, the insurer said today.
With the removal of these 600-plus additional codes, the company has now removed prior authorization on more than 1,100 medical services since 2020. Cigna said the goal is to simplify the healthcare experience both for consumers and for clinicians.
"Our goal is to help keep patients safe, improve health outcomes, and make care more affordable, and this important step will enable us to do that while removing administrative burdens on the healthcare system," said Dr. David Brailer, executive vice president and chief health officer of the Cigna Group.
WHAT'S THE IMPACT?
With the update, prior authorization now applies to less than 4% of medical services for most Cigna Healthcare customers, the company said.
Cigna will also remove prior authorization for nearly 500 additional codes for Medicare Advantage plans later this year, claiming it as part of a larger strategy to streamline its use and optimize care delivery.
While the company will be cutting down on the number of services subject to prior authorization, Cigna maintained that prior authorizations are "an important step" to ensure patient safety and affordability. But the organization has heard from clinicians and health plans who say more can be done to reduce the administrative burden on clinicians.
Cigna Chief Medical Officer Dr. Scott Josephs said the organization will continue to engage with clinicians to align on care delivery goals and outcomes, "and evaluate whether there are other changes we can make without compromising patient safety."
The move comes as industry groups, including the American Hospital Association, American Medical Association and the Blue Cross Blue Shield Association, are pushing the Centers for Medicare and Medicaid Services to reconsider regulatory proposals requiring different electronic standards for data exchange during the prior authorization process.
Along with incentives for providers to adopt electronic prior authorization, CMS' proposed rule, issued late last year, will require payers and states to smooth out their prior authorization processes and improve electronic data exchange by 2026. A Fast Healthcare Interoperability Resources (FHIR) application programming interface (API) will handle the prior authorization.
THE LARGER TREND
Through a rule proposed in December 2022, CMS wants to change prior authorization standards to speed up the time it takes for payers to approve the requests. CMS is proposing to require certain payers, including Medicare Advantage organizations, to implement electronic prior authorization and to send decisions within 72 hours for expedited requests, and seven days for nonurgent requests.
An American Medical Association survey released in March found that 94% of physicians report delays in care associated with prior authorization. Physicians spend almost two business days each week on prior authorization requests, and 35% of them have had to hire additional staff to handle the administrative burden exclusively, the AMA said.
Other survey results show 80% of physicians report that prior authorization can at least sometimes lead to treatment abandonment. Meanwhile, 33% report prior authorization leading to a serious adverse event for a patient in their care – with 9% reporting it's led to permanent bodily damage, disability or death.
Twitter: @JELagasse
Email the writer: Jeff.Lagasse@himssmedia.com
