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Cigna prior authorization form outpatient

Cigna prior authorization form outpatient 2025

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The document is a Medicaid Prior Authorization Request Form for outpatient services, requiring specific member and provider information to be completed for processing. It emphasizes the need for clinical documentation to support service requests, particularly for non-contracted providers. The form outlines the process for expedited requests and includes sections for diagnosis codes, procedure details, and contact information.

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Click ‘Get Form’ to open the Cigna Prior Authorization Form in our editor.
Begin by filling out the Member Information section. Enter the member's name, date of birth, and member ID in the required fields.
Next, complete the Requesting Provider Information. Input the PCP or requesting provider's name, contact person, phone number, and fax number.
If applicable, provide details for the servicing provider. Include their name, tax ID number, NPI number, and contact information.
Select the Type of Service by checking only one box that corresponds to the requested service.
In the Clinical Information section, enter the diagnosis code and procedure/service requested along with any additional clinical details required.
Finally, ensure that you indicate whether supporting clinical information is attached and summarize any necessary details if not.

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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 not covered by Cigna?

Excluded medical equipment includes, but is not limited to: air purifiers, air conditioners, humidifiers treadmills; spas; elevators; supplies for comfort, hygiene or beautification; wigs, disposable sheaths and supplies; correction appliances or support appliances and supplies such as stockings, and consumable medical

What is the number for Cigna prior authorization?

If you are unable to use electronic prior authorization, you can call us at 1 (800) 882-4462 to submit a prior authorization request.

How do I get a prior authorization form from Cigna?

Moving forward, please visit CoverMyMeds at .covermymeds.com/main/prior-authorization-forms/cigna/ or via SureScripts in your EHR to learn more and submit all new PA requests electronically. If you are unable to use electronic prior authorization, please call us at 1.800. 882.4462 (1.800. 88.

Does Cigna cover outpatient?

Your health plan covers you for medical care, in general, regardless of whether its outpatient or inpatient. And some outpatient care may be covered 100% as part of your preventive care. Things like a routine mammogram or routine colonoscopy are examples of outpatient preventive care.

Does Cigna cover outpatient therapy?

Yes, Cigna health insurance typically covers outpatient mental and behavioral health therapy and treatment programs. This coverage includes various services such as individual therapy, support groups, and medication management, allowing you to receive treatment while continuing to maintain your daily activities.

How long does Cigna take for prior authorization?

Typically, within 5-10 business days of receiving the prior authorization request, your insurance company will either: Approve your request. Deny your request.

Does Cigna cover walk in clinics?

Yes, Cigna does cover the cost of urgent care visits.

Cigna prior authorization form outpatient 2025

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