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How to use or fill out Cigna Prior Authorization Form Outpatient with DocHub
- 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. Ensure to attach any supporting clinical information as indicated.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2016 | 4.8 Satisfied (81 Votes) |
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