Cigna sued over algorithm allegedly used to deny claims

[Duaine]

• A lawsuit filed in California on Monday accuses Cigna of using an algorithm to deny claims en masse, instead of individually reviewing each case as required by state health insurance law.
• Cigna’s software, called PxDx, was used to reject more than 300,000 requests for payment over two months in 2022. The average time taken to deny each claim was just 1.2 seconds, according to the suit.
• The payer defended the technology, arguing PxDx is a standard review similar to processes used by other payers.

Cigna specifically is in the hot seat, after a ProPublica investigation earlier this year found Cigna physicians used PxDx to instantly reject claims without opening a patient’s file, leaving patients on the hook for medical bills that, in many cases, should have been covered.

https://www.healthcaredive.com/news...e Dive [issue:52917]&utm_term=Healthcare Dive