Get Cigna Behavioral Health Review Form 2009-2025

Filling out the CIGNA Behavioral Health Review Form online is a crucial step in accessing necessary support for behavioral health services. This guide provides a clear process to ensure that all required information is correctly submitted for timely authorization.

Follow the steps to successfully complete the form.

1. Press the ‘Get Form’ button to access the CIGNA Behavioral Health Review Form and open it for editing.
2. Begin by entering today’s date and the client’s name in the designated fields. Ensure that all information is accurate, as missing data may lead to delays.
3. Fill in the client’s date of birth and the social security number or ID number of the cardholder. This information is essential for identification purposes.
4. Add the facility or program name where the client is receiving treatment, along with the facility’s tax ID, state, zip code, and fax number.
5. Include the submitting staff member's name and credentials, along with their contact phone number.
6. Provide the name and phone number of the attending medical doctor.
7. Indicate the level of care by checking the appropriate box for the treatment phase (e.g., phase 1-4, IOP, low intensity OP, or after-care) and fill in the number of sessions attended and additional sessions requested.
8. Complete the sections for diagnosis, listing any relevant DSM IV codes along with the axes as required.
9. Outline any mental health assessments that have been completed. Offer a plan to address mental health issues if applicable.
10. Document the client’s current medication, including any changes made since the last report.
11. Describe the client’s stage of engagement in substance abuse treatment by marking the relevant line.
12. Answer the status questions regarding the client’s involvement in support programs and treatment engagement. Note any 'No' responses with explanations.
13. Fill in the details of the last use date, current support systems, family/session details, and functional impairment descriptions.
14. Detail the client’s treatment goals and progress, identifying any barriers faced.
15. Outline the criteria for discharge to routine outpatient treatment and specify the planned discharge date if applicable.
16. Complete the aftercare plan section with provider information and confirm any needs for assistance after discharge.
17. Finally, review all entered information for accuracy and completeness. Save changes, download, print, or share the form as needed.

Complete your CIGNA Behavioral Health Review Form online to ensure prompt processing of your authorization request.