Cigna aba request form 2026

1. Click ‘Get Form’ to open the Cigna ABA Request Form in the editor.
2. Begin by filling in the 'Customer Name', 'Date of Birth', and 'Customer ID' fields. Ensure accuracy as this information is crucial for processing your request.
3. Complete the 'Home Address' section, including city, state, and zip code. This helps in identifying the customer’s location.
4. In the next section, provide details about the clinic where the assessment will be performed and the name of the Board Certified Behavior Analyst (BCBA) or Mental Health Provider conducting the assessment.
5. Indicate who should be notified regarding the authorization decision by filling in their name and phone number. Make sure to check if a confidential voicemail is needed.
6. Select the level of benefit requested based on your provider status with Cigna. Provide any necessary details for exceptions if applicable.
7. Enter the customer's diagnosis using an ICD-10 code and confirm whether it was provided by an independently licensed professional.
8. Fill in anticipated start date of assessment and specify authorization requested to a clinic or individual provider along with assessment amount.
9. Lastly, select all applicable standardized assessment tools being used from the list provided. If you choose 'other', ensure to call for further instructions.

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