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CIGNA HealthCare Prior Authorization Form - Proton Pump Inhibitor Medications - Pharmacy Services Phone 800 244-6224 Fax 800 390-9745 Notice Failure to complete this form in its entirety may result in delayed processing or an adverse determination for insufficient information. PROVIDER INFORMATION PATIENT INFORMATION Provider Name Specialty Due to privacy regulations we will not be able to respond via fax with the outcome of our review unless all.

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Contact support

Call Express Scripts at 877-603-1032, and let them do all the work. For most medications, Express Scripts will be able to contact your doctor and arrange for your first mail-order supply. Ask your doctor for a new prescription for up to a 90-day supply, plus refills for up to one year (if appropriate).

Surescripts is privately owned by the National Association of Chain Drug Stores (NACDS), National Community Pharmacists Association (NCPA), CVS Health and Express Scripts.

Please call us at 800.753. 2851 to submit a verbal prior authorization request if you are unable to use Electronic Prior Authorization. Prior Authorization criteria is available upon request.

16 Tips That Speed Up The Prior Authorization Process Create a master list of procedures that require authorizations. Document denial reasons. Sign up for payor newsletters. Stay informed of changing industry standards. Designate prior authorization responsibilities to the same staff member(s).

The healthcare provider is usually responsible for initiating prior authorization by submitting a request form to a patient's insurance provider. As mentioned in the “How does prior authorization work?” section above, this will then often prompt a time-consuming back and forth between the provider and payer.

Report toll-free at 1 (800) 497-1868 or submit your report at .surescripts.com/integrityhelpline. If you are a customer seeking assistance with one of our solutions or have general customer support inquiries, please contact support@surescripts.com or call 1 (866) 797-3239.

Click Reports and search for Prior authorizations....From a patient's chart: Select Add prior authorization from the Actions dropdown. Select a new medication or a medication from the patient's eRx list. ... Request prior authorization. ... Complete and submit question set.

Please call us at 800.753. 2851 to submit a verbal prior authorization request if you are unable to use Electronic Prior Authorization. Prior Authorization criteria is available upon request.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232