Get Cigna Prior Authorization Form 2019

This guide provides clear and comprehensive instructions for filling out the Cigna Prior Authorization Form 2019 online. By following these steps, users will ensure that the form is completed accurately and promptly for efficient processing.

Follow the steps to complete the form successfully.

1. Press the ‘Get Form’ button to access the Cigna Prior Authorization Form 2019 and open it in your editing tool.
2. In the provider information section, fill in your name, specialty, DEA or TIN, office contact person, and contact details including office phone and fax. Ensure all required fields are completed to avoid processing delays.
3. Complete the patient information section by providing the patient's name, CIGNA ID, date of birth, address, and phone number. Again, pay close attention to the mandatory fields marked with an asterisk.
4. In the medication requested field, detail the specific medication, strength, dose, and quantity prescribed per month. Include the associated J-Code.
5. Indicate where the medication will be obtained by selecting one of the options provided: CIGNA Tel-Drug, prescriber’s office stock, retail pharmacy, or home health provider.
6. In the diagnosis section, specify the primary diagnosis, and provide any relevant clinical information such as the patient's current weight and history of prior therapies.
7. Respond to the questions regarding the patient's responses to previous therapies like , , or , and any relevant notes in the additional information section.
8. Once all fields are filled accurately, review the form for completeness before saving your changes. You may then choose to download, print, or share the form as needed.

Start completing your Cigna Prior Authorization Form 2019 online today to ensure timely processing.