Get Cigna Prior Authorization Form For

Filling out the Cigna Prior Authorization Form is an essential step in obtaining necessary medication for patients. This guide provides clear, step-by-step instructions to ensure that users can successfully complete the form online, minimizing any delays in processing.

Follow the steps to complete your Cigna Prior Authorization Form.

1. Click ‘Get Form’ button to access the Cigna Prior Authorization Form and open it in your preferred document editor.
2. Begin by providing the provider information. Fill in the *Provider Name, Specialty, DEA or TIN, Office Contact Person, Office Phone, Office Fax, and Office Street Address along with the City, State, and Zip Code as required.
3. Next, move to the patient information section. Enter the *Patient Name, *CIGNA ID, *Date of Birth, and *Patient Street Address along with the City, State, and Zip Code.
4. Indicate the Patient Phone number and check the boxes regarding the security of your fax machine and whether you may fax the response to your office.
5. Specify the medication requested by including the name, strength, and dosing schedule. For example, ' 10mg' or any other medication as needed.
6. Provide the diagnosis related to the use of the medication, such as 'multiple sclerosis (MS)' or any other relevant diagnosis.
7. Answer whether the medication will be used to improve the patient's walking by selecting 'Yes' or 'No'.
8. Fill in the 'Duration of therapy' section to specify how long the treatment is expected to last.
9. Document any formulary alternatives that have been tried, including the length of trial or if samples were given.
10. Include any additional pertinent information that may support the request, such as clinical reasons for the drug and relevant lab values.
11. After reviewing all the information for accuracy, save your changes, download the form, or prepare it for printing.

Complete your Cigna Prior Authorization Form online today to ensure timely processing and access to necessary medications.