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Enrollee Prescription Drug Claim Form - Cigna - Thank You Macyand#39;s

Enrollee Prescription Drug Claim Form - Cigna - Thank You Macyand#39;s 2026

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The document is a Cigna Medicare Services Enrollee Prescription Drug Claim Form, which allows enrollees to request reimbursement for covered prescription drug expenses. It includes sections for enrollee information, reasons for reimbursement, prescription details, and instructions for completing the form. The form emphasizes the need for accurate information and supporting documentation to avoid claim denial.

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Click ‘Get Form’ to open it in the editor.
Begin by selecting the reason for reimbursement from the options provided. This helps clarify your request.
Fill in your enrollee information, including ID number, RxPCN, name, birth date, and sex. Ensure accuracy for a smooth processing.
In the Enrollee Certification section, confirm that all information is correct and sign where indicated. This step is crucial for validating your claim.
Complete the Prescription Information section for each medication you are claiming reimbursement for. Include details like date filled, drug name, quantity, and amount paid.
If applicable, fill out the Compound Prescription Information section with details provided by your pharmacy.
Review all sections to ensure completeness and accuracy before submitting your claim.

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Versions	Form popularity	Fillable & printable
2015	4.8 Satisfied (42 Votes)
2013	4.2 Satisfied (71 Votes)
2012	4.3 Satisfied (76 Votes)

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is a claims submission address?

Correct claims address means the address appearing on an enrollees or insureds current identification card issued by the health insurance issuer as the current address at which claims are received, or, if no address appears on the identification card, the current address for receipt of claims provided by the health

Where do I send Cigna claim forms?

If you use a pharmacy that does not participate in your plans network, your prescription may not be covered, or reimbursement may be limited by your plans copayment, coinsurance or deductible requirements. Refer to your plan documents for costs and complete details of your plans prescription drug coverage.

What is the address for Cigna claims 182223?

You may submit out-of-network claims electronically by going to myCigna.com* or through the mail to Cigna Claims, P.O. Box 182223, Chatanooga, TN, 37422-7223 or the address on the back of your ID card.

How do I submit a claim to Cigna?

To submit a supplemental health claim: Email: SuppHealthClaims@Cigna.com. Fax: 1 (860) 730-6460. Mail: Cigna Healthcare Phoenix Claim Services. PO Box 55290. Phoenix, AZ 85078.

Why is Cigna not covering my prescription?

Prescription Drug Claim Form. This claim form is to be used for reimbursement on covered medications provided by pharmacies.

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How long do you have to submit claims to Cigna?

When to File Your Claims If you aresubmit by A participating health care provider 90 days after the date of service An out-of-network provider 180 days after the date of service

Enrollee Prescription Drug Claim Form - Cigna - Thank You Macyand#39;s 2026

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