Get Cigna 803127 2015-2025

This guide provides detailed instructions on how to complete the Cigna 803127, also known as the Enrollee Prescription Drug Claim Form. By following these steps, you can efficiently submit your claim for reimbursement of covered prescription drug expenses.

Follow the steps to successfully complete the Cigna 803127 form online.

1. Press the ‘Get Form’ button to obtain the Cigna 803127 document and open it in your preferred editing tool.
2. In the 'Reason for reimbursement' section, select one of the options that best describes your request for reimbursement. Provide any necessary explanations where indicated.
3. Fill out the 'Enrollee Information' section by entering your ID number, RxPCN, name, birth date, and sex. Ensure all details are accurate as this information is crucial for processing your claim.
4. In the 'Enrollee Certification' section, read through the certification statement and then sign and date the form. Be sure to include your daytime phone number.
5. Complete the 'Prescription Information' section for each medication you are requesting reimbursement for. Enter details such as the date filled, Rx number, quantity, day supply, drug name, prescribing doctor’s name, amount paid, doctor’s phone number, and pharmacy details.
6. If you are claiming for a compound prescription, use the 'Compound Prescription Information' section. Fill in the required fields, including the ingredients and dispensing fee, ensuring this section is completed by the pharmacy.
7. Once all sections are fully completed, review your form for any missing information, as incomplete claims may be denied.
8. Make a copy of the completed form and all prescription receipts for your records before submission.
9. Mail your completed form and receipts to the specified address: Cigna-HealthSpring Pharmacy Service Center, P.O. Box 20002, Nashville, TN 37202.
10. If you encounter any issues or need assistance, do not hesitate to contact the customer service number listed on your prescription drug ID card.

Complete your Cigna 803127 form online today to ensure you receive your reimbursement timely.