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  • Cigna Healthcare Prior Authorization Form - 2010

Get Cigna Healthcare Prior Authorization Form - 2010-2025

Risked (*) items on this form are completed** * DEA or TIN: Office Contact Person: * Patient Name: Office Phone: * CIGNA ID: Office Fax: * Date Of Birth: * Is your fax machine kept in a secure location? * May we fax our response to your office? Yes Yes No No Office Street Address: City * Patient Street Address: City State Zip State Zip Patient Phone: Medication requested: Strength & Dose: J-Code: Quantity per month: Where will this medication be obtained? CIGNA Tel-D.

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A prior authorization (PA), sometimes referred to as a pre-authorization, is a requirement from your health insurance company that your doctor obtain approval from your plan before it will cover the costs of a specific medicine, medical device or procedure.

Prior authorization sometimes called precertification or prior approval is a health plan cost-control process by which physicians and other health care providers must obtain advance approval from a health plan before a specific service is delivered to the patient to qualify for payment coverage.

Typically within 5-10 business days of hearing from your doctor, your health insurance company will either approve or deny the prior authorization request. If it's rejected, you or your doctor can ask for a review of the decision.

Prior authorization is a way for a PPO to make sure it's only paying for healthcare services that are really necessary, so the insurers might require you to get pre-authorization before you have expensive tests, procedures, or treatments.

When does the precertification review happen? The review process can happen at three different times: Cigna receives a request before you receive care (prospective review). Decisions are made within two business days of receiving all necessary information.

In support of this policy and procedure, the Cigna-HealthSpring Provider Manual policy now states: ... Cigna-HealthSpring does require the retro authorization request and applicable clinical information to be submitted to the Health Services department within 1 business day of providing the service.

Depending on a patient's plan, you may be required to request a prior authorization or precertification for any number of prescriptions or services. A full list of CPT codes are available on the CignaforHCP portal .

Prior authorization can take days to process. Within a week, you can call your pharmacy to see if the prior authorization request was approved. If it wasn't, you can call your insurance company to see why the authorization was delayed or denied..

Health care providers usually initiate the prior authorization request from your insurance company for you. However, it is your responsibility to make sure that you have prior authorization before receiving certain health care procedures, services and prescriptions.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232