To ensure timely access to medical care, HealthSpring^SM is adopting Centers for Medicare & Medicaid Services guidelines for turnaround time standards for prior authorization for our Medicare members, effective January 1, 2026.

What’s changing

HealthSpring is reducing response times to up to seven calendar days for nonurgent preservice and concurrent prior authorization and admission notification. The previous response time was up to 14 calendar days

We may extend the response time up to an additional 14 days when a member or provider requests an extension, or we request additional clinical information for prior authorization processing.

If the response time is extended, we’ll send a notification letter to you and the affected member explaining the delay in prior authorization determination. The notice will include information on a member’s right to file an expedited grievance if they disagree with the extension.

Additional process changes in 2026

Things to know in 2026

With these changes, please be aware of the following:

• Facilities are encouraged to utilize the provider portal, Availity Essentials^TM, to perform clinical tasks. 
• Facilities must be clear about the level of care when making a request (e.g., inpatient acute or observation). If an observation level of care is requested and approved, a subsequent order for admission to inpatient status requires that a new authorization request be submitted. The inpatient level of request will be a separate determination.
• Outpatient observation notification and authorization should be submitted via the Provider Portal accessible within the Availity Essentials Payer Space  as an “inpatient” authorization type but an “observation” bed type.
• A one time, pre-decision, peer to peer may be requested during the initial concurrent review process and prior to an auth decision being made. Following the authorization decision, a change cannot be made outside of the appeals process. New or additional information, including but not limited to a change in status, new event, or decompensation in clinical status for reconsideration may only be submitted via appeal.
• Please refer to the applicable appeals instructions which will be communicated via the denial notice and are accessible within the Healthspring Provider Manual.

If you have questions about this change, please contact Maria.Galick@Healthspring.com.

Cigna Healthcare^® Medicare Advantage is becoming HealthSpring^SM.Our new benefit plans will be rolled out under the HealthSpring name during the 2025 annual enrollment period. Starting in January 2026, you will begin seeing patients with HealthSpring benefit coverage. Learn more.