Get Cigna Multiple Sclerosis Psc Prior Authorization Form 2020

Filling out the Cigna Multiple Sclerosis PSC Prior Authorization Form accurately is crucial for ensuring timely medication approval. This guide provides straightforward instructions for completing the form online, enabling users to navigate through each section with confidence.

Follow the steps to successfully complete the form online.

1. Press the ‘Get Form’ button to access the Cigna Multiple Sclerosis PSC Prior Authorization Form and open it in your preferred editor.
2. Begin by entering the physician information. Provide the physician's name, specialty, and the appropriate identification numbers (DEA, NPI, or TIN). Ensure all fields marked with an asterisk (*) are completed to comply with privacy regulations.
3. Next, fill in the patient information, including the patient's name, Cigna ID, date of birth, and contact details. Verify the accuracy of the patient’s street address, city, state, and zip code.
4. Indicate the urgency of the request by checking either the 'Standard' or 'Urgent' option. If urgent, confirm that immediate processing is necessary due to health implications.
5. List the medication requested from the provided options. Specify the dose, quantity, duration of therapy, and frequency of administration. Be thorough with these details to facilitate review.
6. Determine if this is a new start or a continuation of therapy. If it's a continuation, specify previous approval details and treatment history.
7. Provide information about where the medication will be obtained and the facility administering it. Include facility name and address, ensuring all fields are completed.
8. Complete the diagnosis section by selecting the relevant condition the patient is experiencing. Include any pertinent clinical information to support the request.
9. Document any previous treatments and responses, including failures or intolerances to other drugs in the same class. Provide detailed explanations for better assessment.
10. After you have filled out all necessary sections, review the form for accuracy and completeness. Make necessary adjustments.
11. Once satisfied, save the changes. You may download, print, or share the completed form as required.

Complete your Cigna Multiple Sclerosis PSC Prior Authorization Form online today and ensure timely medication approval.