Get Cigna Genetic Counseling Recommendation Form - Genedx

Filling out the Cigna Genetic Counseling Recommendation Form - GeneDx online is a straightforward process designed to collect necessary information for genetic testing recommendations. This guide provides step-by-step instructions to ensure you successfully complete the form with all required details.

Follow the steps to fill out the form accurately.

1. Press the ‘Get Form’ button to access the Cigna Genetic Counseling Recommendation Form - GeneDx. This will allow you to open the document and start filling it out.
2. In the Customer (Patient) Information section, enter the patient's name, ID number, date of birth, and date of consultation accurately. This information is essential for identifying the patient.
3. Next, provide the Genetic Clinical Nurse, Advanced Practice Nurse in Genetics, Genetic Counselor, or Clinical Geneticist information. Fill in their name, street address, city, state, zip code, tax ID, telephone, and fax information.
4. In the Ordering Healthcare Professional Information section, input the name, street address, city, state, zip code, telephone, and fax numbers of the ordering healthcare professional.
5. For the Rendering Lab Information, enter the details for GeneDx, including the street address (207 Perry Parkway, Gaithersburg, MD, 20877), telephone (301-519-2100), and fax (201-421-2010).
6. Complete the Requested Test(s) Information section by specifying the names of the requested tests along with the appropriate CPT/HCPCS codes.
7. In the Recommendation section, choose one of the provided options regarding the individual's eligibility for testing. Ensure you clearly state any reasons or explanations required for your recommendation.
8. Affirm your qualifications by checking the box to confirm that you are a Genetic Clinical Nurse, Advanced Practice Nurse in Genetics, board-certified Genetic Counselor, or a board-certified Clinical Geneticist.
9. Finally, sign the form and include the date of completion. Double-check all entered details for accuracy.
10. Once you have completed the form, along with a 3-generation pedigree, a copy of the Ordering HCP’s Lab Requisition Form, and a photocopy of your evaluation, fax it to Cigna at 855-245-1104 for submission.

Start filling out the Cigna Genetic Counseling Recommendation Form - GeneDx online today for a smooth and efficient process.