Get Cigna Prior Authorization Form

Completing the Cigna Prior Authorization Form is an important step in ensuring that patients receive the necessary medications and treatments. This guide provides clear, step-by-step instructions to help users fill out the form efficiently and accurately, promoting a smooth authorization process.

Follow the steps to complete the Cigna Prior Authorization Form online

1. Press the ‘Get Form’ button to access the Cigna Prior Authorization Form and open it in the editing tool.
2. Begin by selecting whether this request is for a new start of treatment or for continued treatment by checking the appropriate box.
3. Fill in the patient information by providing the patient's name, address, telephone number, and patient ID. Ensure that all details are printed clearly.
4. Next, you will need to enter the prescribing physician's information, including their name, office address, and contact details.
5. Indicate the date medication is needed and provide the patient's date of birth and weight.
6. In the diagnosis section for the requested drug, provide the necessary ICD-10 code.
7. Complete the patient medical information section relevant to the condition being treated, ensuring to answer all questions accurately.
8. For prescription information, indicate the quantity requested, the number of refills, and detailed instructions for administering the medication.
9. Finally, ensure the physician's signature is included. Review the completed form thoroughly for accuracy.
10. When you have finished, save your changes, then download, print, or share the completed form as necessary.

Take the necessary steps to complete your documents online with ease.