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  • West Tn Practitioner Interest Form - Cignacom

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(West TN/North MS/East AR) PHONE: (901) 8445400, Ext. 505481 FAX: (615) 5649085 WEST TN PRACTITIONER INTEREST FORM PLEASE PRINT Contact Person: Date: Provider Name: NPI #: Provider Telephone #: Provider.

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You or your provider will need to submit a claim. If your provider does not submit a claim, you will need to submit one in order to be reimbursed. In both cases, you will be reimbursed based on the amount covered by your plan and subject to your plan's deductible, copay, or coinsurance requirements.

Depending on a patient's plan, you may be required to request a prior authorization or precertification for any number of prescriptions or services. A full list of CPT codes are available on the CignaforHCP portal.

You can get a new blank form by going to .cigna.com/customer-forms and clicking on the "Medical Claim Form" link under "Medical Forms", or by calling Customer Service at the toll-free number on the back of your ID card. To process your claim, we need your ID number (Primary Customer Section, Block D).

The Cigna Connect Network is an Exclusive Provider Organization (EPO), which gives you access to local providers selected with cost and quality in mind.

In the event that your plan has been automatically renewed in any year following your initial purchase and provided that your discount plan benefits have not been used, a full refund will be issued within the first 60 days of the automatic renewal.

Mail Claim Forms To: Cigna P.O. Box 188061 Chattanooga, TN 37422-8061 Electronic Payor ID: 62308 1.

Submit your invoice and claims to us: - Online via your secure online Customer Area; - Or via email, fax, or post (See page 13). We will reimburse you (less your applicable deductible and/or cost share option). We aim to process your claim within 5 working days after receiving all necessary documentation.

Getting reimbursed To download the appropriate Health Care Reimbursement Request Form, visit Customer Forms. Read the claim form closely, and call us at 1 (800) 244-6224 if you have questions. One claim form can be used to request up to three expenses. ... Mail or fax claim forms to Cigna HealthcareSM

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232