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Pre-authorisation agent for Cigna

The pre-authorisation agent for Cigna gathers what a pre-authorisation needs before a planned procedure.

Riverside Family ClinicPre-authorisation agentWhatsApp
  1. Customer: I need a knee scope next month. What do I do?
  2. Read the plan’s authorisation rulesCigna
  3. Pre-authorisation agent: You’ll need authorisation before you’re admitted. Your plan guide asks for the doctor’s quote with the procedure codes and the hospital’s name. Do you have the quote?
  4. Customer: I’ll send a photo.
  5. Quote received: codes and hospital foundHealth Loops
  6. Complete request sent to the authorisation team
Sample conversation. People, brands and figures are made up.

What it can do with Cigna

  • Reads the Cigna authorisation rules for the member’s plan and gathers what they need
  • Match the member to their Cigna option from the 3 on file (Open Access Plus, LocalPlus and Global Health), with their membership number, from a message or a photo of their card
  • Answer general questions about Cigna cover, and send plan-specific ones to the Cigna service line rather than guess
  • Read a claims or benefit statement the member sends and explain each line still owed, in plain words

Questions

What does the pre-authorisation agent do with Cigna?

Reads the Cigna authorisation rules for the member’s plan and gathers what they need.

Is the Cigna connector live?

Yes.

Does the pre-authorisation agent approve procedures?

No.

Does the agent decide Cigna claims or authorisations?

No.

Does the agent triage or diagnose patients?

No.

Ollie’s agents give wellness guidance. They don’t diagnose or prescribe, and hand off to a human expert when needed.