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The prior authorization, or pre-certification process, requires healthcare providers to get coverage approval for certain non-emergency procedures. Cigna removes pre-authorization requirement for ...
After a request comes in from a qualified provider, the request will go through the prior authorization process. The process to obtain prior authorization varies from insurer to insurer but typically involves the completion and faxing of a prior authorization form; according to a 2018 report, 88% are either partially or entirely manual.
Specialty services require a specific referral from the PCP to the specialist. Non-emergency hospital admissions also require specific pre-authorization by the PCP. Typically, services are not covered if performed by a provider not an employee of or specifically approved by the HMO unless it defines the situation to be an emergency.
The Cigna Group is an American multinational for-profit managed healthcare and insurance company based in Bloomfield, Connecticut. [2] [3] Its insurance subsidiaries are major providers of medical, dental, disability, life and accident insurance and related products and services, the majority of which are offered through employers and other groups (e.g., governmental and non-governmental ...
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Cigna, which got into the Medicare Advantage business with an $3.8-billion acquisition of HealthSpring in 2011, would be backing away at a time when the U.S. government is tightening its purse ...
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Employers with 25 or more employees were required to offer federally certified HMO options alongside indemnity upon request; This last provision, called the dual choice provision, was the most important, as it gave HMOs access to the critical employer-based market that had often been blocked in the past.
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