Get Cigna Transition Of Care Request Form

Filling out the CIGNA Transition Of Care Request Form online is an essential step for individuals seeking continued care from non-participating health care providers. This guide provides a step-by-step approach to ensure that users can easily navigate and complete the form to access their Transition of Care benefits.

Follow the steps to fill out the CIGNA Transition Of Care Request Form easily.

1. Press the 'Get Form' button to acquire the form and open it in your preferred editor.
2. Begin by filling in the employer's name and policy number, along with the employee's name and home address, including street, city, state, and zip code.
3. Provide the patient’s details, including name, date of birth, social security number, and their relationship to the employee.
4. Indicate the employee's date of enrollment in the CIGNA benefit plan.
5. Answer the questions regarding the patient's current circumstances, including pregnancy status, ongoing treatments, scheduled surgeries, and any involvement in specialized therapies.
6. Complete the medical professional's information section with details about the group practice name, doctor's name, contact details, specialty, and hospital affiliation.
7. Provide a description of the reason for the Transition of Care request, including dates of admission, surgical details, and the expected duration of treatment.
8. Sign the authorization section of the form, including the date of signature, ensuring that the correct individual (patient, parent, or guardian) signs.
9. Review the completed form for accuracy and completeness, then submit it to the appropriate address provided in the instructions.

Complete your CIGNA Transition Of Care Request Form online to ensure a smooth transition for your health care needs.