6/5/2024
To support faster turnaround time on claims for Midlands Choice contracted providers, Cigna has developed a report to catch the number of claims denying for no prior authorization, since this creates rework for the provider as well as payers claims teams. When a prior authorization is required from the payer or the group’s benefit plan and one is not obtained, a denial is generated. When this happens, the provider must then obtain a retro authorization, medical records are required to be sent, and a review must be completed at the insurance company to allow the procedure before the claim can be processed.
Providers are encouraged to check the back of the patient’s ID card for information as to where to call for benefits and eligibility and the prior authorization phone number.
- Visit www.cignaforhcp.com website or www.mycigna.com website for a listing of the procedures needing an authorization.
- When in doubt, providers may call the authorization number to verify if an authorization is needed. Callers may be transferred to an area that can authorize the procedure if it is a surgery or a high-tech radiology procedure. Upon approval, the authorization will be noted in Cigna’s client database so when the claim is submitted it will be set to process as benefits allow.
Getting the preauthorization completed up front can reduce claims turnaround time on average of 60 to 90 days.