Get Cigna 591692d 2023-2025

The Cigna 591692d is a medical claim form that is essential for filing claims when your health care professional does not submit them on your behalf. This guide will provide step-by-step instructions to help users complete the form accurately and efficiently online.

Follow the steps to complete the Cigna 591692d form online.

1. Click the ‘Get Form’ button to obtain the Cigna 591692d form and open it in your preferred editor.
2. Fill in the primary customer information accurately. Start with the primary customer's name, including first name, last name, and middle initial.
3. Provide the date of birth and gender of the primary customer, followed by the mailing address details, including street, city, state, and zip code.
4. Include the Cigna ID number or social security number, and indicate if this is a change of address. Also, select the primary customer status (employed, retired, COBRA, or disabled) and complete the employer name if applicable.
5. If the patient is not the primary customer, fill out the patient information section, including their name, relationship to the primary customer, date of birth, and address if different from the primary customer.
6. Complete the accident/occupational claim information if applicable. Document the cause of the accident or illness, and provide the date and description of how it occurred.
7. In the family/other coverage information section, detail if the spouse is employed, their employer's name and address, and any other relevant health insurance coverage details.
8. Read the certification statement carefully, then sign and date the form in the designated areas.
9. Authorizing payment directly to a health care professional is optional, but if you choose to do so, sign the payment instructions section.
10. Review all entered information for accuracy. Once satisfied, save your changes, download a copy of the completed form, and print it if necessary.
11. Follow the mailing instructions to send the completed claim form and itemized bills to the address listed on your ID card.

Complete your Cigna 591692d form online today to ensure timely processing of your medical claims.