Get Cigna ( Type A) 2021-2025

Filling out the CIGNA (Type A) form online is essential for ensuring proper authorization of treatment. This guide will walk you through each section of the form, ensuring all necessary information is accurately provided.

Follow the steps to complete the CIGNA (Type A) form accurately.

1. Press the ‘Get Form’ button to access and open the CIGNA (Type A) form.
2. Provide patient information, including name, date of birth, contact details, and CIGNA ID. Ensure all mandatory fields marked with an asterisk (*) are completed.
3. Enter physician information, including physician name, specialty, office contact person, and attaching their DEA, NPI, or TIN if required.
4. Select the urgency level of the request by indicating either 'Standard' or 'Urgent'. For urgent requests, confirm that the urgency is warranted by ticking the appropriate box.
5. Fill in the medication request by selecting the appropriate vial and indicating total dose requested, frequency of administration, and quantity.
6. List all muscles or sites where will be injected, including the specific number of units for each site.
7. Indicate the duration of therapy and enter necessary codes: J-Code, CPT Code, and ICD10, as applicable.
8. Specify whether this is for new or continued therapy, answering additional questions about treatment response if it's continued therapy.
9. State where the medication will be obtained, selecting from the available options provided.
10. Complete the section regarding diagnosis and provide details for necessary support documentation, ensuring to complete all relevant questions.
11. Finish by signing the attestation confirming the accuracy of the information provided and date it appropriately.
12. Once completed, save any changes, and consider options to download, print, or share the form as needed.

Start filling out the CIGNA (Type A) form online now to ensure a smooth authorization process.