In response to recent media misrepresentations, Cigna Healthcare, the health benefits provider of The Cigna Group (NYSE: CI), today shared information about one of its processes used to expedite payments to health care clinicians for a small number of relatively low-cost procedures. Cigna believes that the inaccurate portrayal of the PxDx – or “procedure to diagnosis” – process may lead to confusion or misunderstanding about how it works and how it is used.
Here are the facts about this claims review process:
- PxDx is a simple process that has successfully helped accelerate payments to physicians for common, relatively low-cost tests and treatments over the last several years. The post-treatment review process works through software (not artificial intelligence or an algorithm) that matches the codes submitted by the physician with diagnosis codes that are considered medically necessary for a procedure under Cigna’s publicly posted clinical coverage policies.
- Patients are not denied care through this review in any way – it occurs after the patient has received treatment and once their physician bills for the treatment.
- Most individuals do not experience any additional costs if their claim is denied via PxDx. If a patient received care from an in-network provider, the provider should not bill them if payment on a specific service is not paid via PxDx.
- This process is used for approximately 50 low-cost tests and procedures that are only covered for specific diagnoses – such as dermabrasion, chemical peels, or vitamin D screenings.
- The vast majority of claims reviewed through this process are automatically paid. Claims that are denied for payment through this process represent less than 1% of Cigna Healthcare’s total volume of claims.
- Similar versions of this process are used by the Centers for Medicare & Medicaid Services (CMS) and other health insurers.
More information about this claims review process is available hereThis link will open in a new tab..
About Cigna Healthcare
Cigna Healthcare is a health benefits provider that advocates for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Products and services are provided exclusively by or through operating subsidiaries of The Cigna Group (NYSE:CI), including Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company, Evernorth Health companies or their affiliates and Express Scripts companies or their affiliates. Such products and services include an integrated suite of health services, such as medical, dental, behavioral health, pharmacy, vision, supplemental benefits, and others. Learn more at cignahealthcare.com.