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How to fill out the Cigna Memphis Form online
Filling out the Cigna Memphis Form online is a straightforward process that helps ensure your request for medications is submitted accurately. This guide will provide step-by-step instructions to assist you in completing the form effectively.
Follow the steps to fill out the Cigna Memphis Form online.
- Click the ‘Get Form’ button to obtain the form and open it in the editor.
- Begin with the provider information section. Enter the provider's name, specialty, DEA or TIN, office contact person, phone number, and fax number.
- In the patient information section, fill in the patient's name, Cigna ID, date of birth, street address, city, state, zip code, and phone number.
- Indicate whether the fax machine is kept in a secure location and if the response may be faxed to the office. Check 'Yes' or 'No' as applicable.
- Next, specify the medication requested from the available options, noting the correct strengths and dosages.
- Provide the diagnosis related to the medication use by selecting from options such as Erectile Dysfunction or PAH, or specify if other.
- If the diagnosis is Erectile Dysfunction, indicate its origin, whether hormonal, neurogenic, or vasculargenic, and provide relevant details as required.
- For PAH diagnosis, confirm if there has been a failure, contraindication, or intolerance to specified drugs and provide details where prompted.
- After filling in all required fields, review the form for accuracy and completeness to avoid processing delays.
- Finalize your submission by faxing the completed form to (800)390-9745.
- For urgent requests, contact Pharmacy Services directly at (800)244-6224.
Complete your Cigna Memphis Form online today to ensure prompt processing of your medication request.
Cigna does provide coverage for Ozempic, but it may depend on your specific plan and circumstances. It is advisable to refer to your plan documents or contact Cigna directly for details about coverage, co-pays, and any prior authorization required. Understanding these details can facilitate a smoother claims process.
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