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"A Cigna algorithm flags mismatches between diagnoses and what the company considers acceptable tests and procedures for those ailments." "Cigna said its revie
by SapporoChris 4y ago
"A Cigna algorithm flags mismatches between diagnoses and what the company considers acceptable tests and procedures for those ailments."
"Cigna said its review system was created to “accelerate payment of claims for certain routine screenings,”
This sounds like simple automation with an error rate that is acceptable by Cigna. Of course it's not acceptable to anyone wrongfully denied a claim.
Now that's an issue I don't see in the article. How many claims were wrongfully denied? I can't get worked up about the situation when critical information is missing.
- ahi 4y agoThey are not legally allowed to automate this. These cases MUST be reviewed by qualified medical personnel.
- magicalist 4y ago> Now that's an issue I don't see in the article. How many claims were wrongfully denied? Well gee, to actually estimate that you'd need a medical expert to review the claims.
- IG_Semmelweiss 4y agoNot only the automation is a problem. Cigna is the only one that knows the rule set. This forces the patient or biller to try out multiple combination of codes until he strikes told. This is why healthcare is so expensive. Remove cpts and icds and the admin overhead syatem goes away But that requires insurances to be there for catastrophic care only (I.e. reverse lottery) , and this is not palatable with the govt crowd