Get Cigna Dme Prior Authorization Form

Filling out the Cigna Dme Prior Authorization Form accurately is essential for ensuring timely processing of requests for durable medical equipment. This guide presents a comprehensive, step-by-step approach for completing the form online, making the process easier for users. Follow these instructions to ensure all necessary details are included for a smooth submission.

Follow the steps to complete your DME prior authorization request effectively.

1. Press the ‘Get Form’ button to access the Cigna Dme Prior Authorization Form and open it in your preferred online editor.
2. Begin by filling in the provider information section. Include the provider’s name, contact information, phone number, fax number, and date of service. Ensure that all details are accurate.
3. In the member information section, provide the member's name, member ID number, date of birth, and the previous authorization number if applicable. Also, specify the ordering medical doctor and their fax number.
4. Indicate the diagnosis using the relevant ICD-9 codes associated with the request. Ensure that these codes correspond to the medical condition being addressed.
5. Select the request type; choose either ‘Standard’ or ‘Expedited’. If you select ‘Expedited’, read the statement regarding time frames and confirm that it is necessary by signing the form.
6. Document the oxygen saturation level if required in the initial setup, as per the form's instructions.
7. Complete the section listing the durable medical equipment items requested along with their respective quantities and HCPCS codes. Ensure that this information is complete and matches what was prescribed.
8. Review all filled sections for accuracy and completeness before proceeding.
9. Upon final review, save your changes, download or print the form, and fax it to the provided fax number along with any required information.

Complete your Cigna Dme Prior Authorization Form online today to facilitate your equipment requests.