Get Cigna Form

Filling out the Cigna HealthCare Prior Authorization Form online is an essential process for ensuring timely access to medications. This guide will provide you with clear, step-by-step instructions to assist you in completing the form accurately and efficiently.

Follow the steps to complete the Cigna Form online.

1. Click 'Get Form' button to obtain the Cigna HealthCare Prior Authorization Form and open it in the online editor.
2. Begin by entering your provider information in the designated fields. This includes your provider name, specialty, DEA or TIN, office contact person, office phone, and office fax.
3. Next, fill in the patient information. Required fields include the patient's name, Cigna ID, date of birth, patient street address, city, state, zip code, and patient phone number.
4. Indicate whether your fax machine is kept in a secure location and if you consent to receive the response via fax. Both questions require 'Yes' or 'No' responses.
5. In the medication requested section, select the dosage required along with the duration of therapy. You will also need to specify the J-Code and where the medication will be obtained.
6. Proceed to provide the diagnosis related to the use, including details about the patient's current weight and any previous responses to therapy.
7. Document any prior evidence of failure, intolerance, or contraindication to disease-modifying anti-rheumatic drugs, checking all that apply.
8. For measuring disease progression, check all applicable assessment methodologies used before therapy on .
9. If this is a request for continued therapy, indicate the positive responses to treatment and any additional information regarding patient history with TNF blockers.
10. After completing all required fields and sections, ensure that you review the form for any missing information. Once satisfied, you can save changes, download, print, or share the form as needed.

Complete your Cigna Form online today for a smooth and timely authorization process.