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Get Cigna Prior Authorization Outpatient Form Printable
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How to fill out the Cigna Prior Authorization Outpatient Form Printable online
This guide provides a straightforward approach to filling out the Cigna Prior Authorization Outpatient Form Printable online. By following these instructions carefully, users can ensure that their submissions are complete and accurate, thereby facilitating timely processing.
Follow the steps to successfully complete the form.
- Click the ‘Get Form’ button to access the Cigna Prior Authorization Outpatient Form Printable and open it in your preferred editing tool.
- Enter the provider information in the designated fields. Include your name, specialty, DEA or TIN, office contact person, office phone, and fax number.
- Fill out the patient information section thoroughly. Provide the patient’s name, Cigna ID, date of birth, street address, city, state, zip code, and phone number.
- Indicate whether the fax machine at your office is kept in a secure location and if the response can be faxed to your office by answering the related questions.
- Specify the medication requested, including the name among the options provided (e.g., ), along with the strength and dose.
- Document the diagnosis related to the medication use, selecting from options such as symptomatic osteoarthritis, symptomatic rheumatoid arthritis, and any other related conditions.
- Answer questions about adverse reaction risks, including whether the patient has a gastrointestinal-related diagnosis, is currently using oral corticosteroids, and is currently using anticoagulants.
- Please indicate any concurrent NSAID use within the last 30 days, including dosages and relevant dates.
- Once all the sections are complete, review for accuracy, and then save your changes, download, print, or share the filled-out form as needed.
Start filling out your Cigna Prior Authorization Outpatient Form Printable online today!
A prior authorization request form is a specific document submitted to insurance carriers, requesting approval for a medical service or prescription. It includes information about the patient and the proposed treatment. The Cigna Prior Authorization Outpatient Form Printable is designed to streamline this request, ensuring that all required details are included.
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