Cigna To Shed Certain Prior Authorization Requirements, May Benefit Home-Based Care Providers

In an attempt to lower administrative burden, Cigna Healthcare — the health insurance arm of The Cigna Group (NYSE: CI) — announced that it is removing nearly 25% of medical services from its prior authorization requirements.

Broadly, prior authorization is the process that occurs when a health care provider requests a patient to receive a specific service, medication or procedure. The health insurance company then has to give the go-ahead.

From the home care and home health provider perspective, prior authorization can include a lot of tedious back office work, and it can also hurt patient care.


The process is put in place to ensure the health plan is going to cover the care and financial costs for a patient down the road.

Traditional prior authorization is not a seamless process. Patients can wait days – or weeks – to see if their care has been authorized. When there are significant delays, patients are much more likely to abandon their treatment plan altogether.

Since 2020, Cigna has removed prior authorization on more than 1,100 medical services in hopes of simplifying the health care journey for both health care providers and patients.


Cigna also plans to remove prior authorization for nearly 500 additional codes for Medicare Advantage plans later this year.

“Prior authorizations are an important step to ensure patient safety and affordability, but clinicians and health plans alike agree that more can be done to reduce the administrative burden on clinicians,” Cigna Healthcare CMO Scott Josephs said in a statement. “We 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.”

Home health providers have longed for a speedier prior authorization process. Home Health Care News reached out to Cigna to find out whether any of the prior authorizations removed were home health- or home care-related, but had not heard back by the time this story was published.

Either way, large insurers like Cigna and UnitedHealthcare – which has also done away with some prior authorization – moving away from prior authorization is a positive. Health care providers are likely to find these insurers are easier to work with in the future.

Better prior authorization

Digitizing the process has helped tremendously in some cases.

A study from America’s Health Insurance Plans (AHIP) found that when requests were submitted electronically, the prior authorization process fell from an average of 18.7 hours to 5.7 hours — a reduction in turnaround time of nearly 70%.

In July, the U.S. House Ways and Means Committee advanced the Improving Seniors’ Timely Access to Care Act, which was designed to improve health care for seniors by, in part, reducing those burdensome prior authorization processes.

The legislation would mandate the adoption of electronic prior authorization for Medicare Advantage plans. The bill also would improve transparency when it comes to MA policies, approval rates and the rationale behind requests being denied.

That bill is currently waiting on a score from the Congressional Budget Office.

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