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Providence prior authorization form

Providence prior authorization health plan 2026

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The document is a Prior Authorization Request form for high-tech imaging services, requiring specific patient and provider information, including ICD-10 and CPT codes. It provides contact details for submitting the request via fax or phone, emphasizes the need for expedited processing due to potential health risks, and includes a confidentiality notice.

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Click ‘Get Form’ to open the providence prior authorization health plan in the editor.
Begin by filling out the Member Information section. Enter the Last Name, First Name, ID #, DOB, and Address. Ensure accuracy as this information is crucial for processing your request.
Next, complete the Provider Information section. Fill in details for both the Requesting Provider and Servicing Provider, including TIN#, NPI#, and Address.
In the Request Information section, input the ICD-10 Code(s) and CPT Code(s). Specify the Requested Services and indicate if it includes Office Visits or Surgery.
Select the Type of Service from options such as Inpatient or Outpatient Surgery. Fill in the Date of Service (DOS) and Date Span Requested.
Finally, provide your Contact Information in the REQUIRED section. Include a Phone # and Fax # to ensure prompt communication regarding your request.

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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.

Does Cigna work with Providence?

When members live or travel outside of Providences service areas, our partnership with Cigna Healthcare allows members to access Cigna Healthcare providers, specialists, and hospitals at the in-network rate. This ensures that our members receive quality care and have nationwide access to care.

What companies are part of Cigna?

In jurisdictions outside the USA and Canada, products and services are offered by or through Cigna Global Insurance Company Ltd. or affiliates and contracted companies. CareAllies Provider Collaboration Solutions. eviCore healthcare. Express Scripts PBM Services. Accredo specialty pharmacy services.

Does Providence have a PPO plan?

Save money through lower out-of-pocket expenses, not only because of the practitioners agreement to offer preferred rates, but because the PPO health insurance may offer a higher level of benefits when you use Providence Preferred providers and facilities.

What is an alliance with Cigna?

Some of your patients may have a plan offered through a Cigna Strategic Alliance. This means Cigna and another health plan jointly market benefit plans or share in the administration of the plan (e.g., we may perform claim re-pricing and other services).

What is plan required prior authorization?

Prior authorization is a health plan cost-control process that requires providers to qualify for payment by obtaining approval before performing a service.

providence prior authorization

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Is Providence Health Plan part of Cigna?

Cigna Healthcare is an independent company and not affiliated with Providence Health Plan. Access to the Cigna PPO Network is available through Cigna Healthcares contractual relationship with Providence Health Plan.

What is the phone number for Providence Health Plan prior authorization?

All inpatient, residential, day, intensive outpatient, or partial hospitalization treatment Services, and other select outpatient Services must be Prior Authorized. For questions or assistance with the prior authorization request process, please call customer service at 800-878-4445.

How to get prior authorization for health insurance?

Your doctors office is responsible for obtaining prior authorization. They will submit a request to your insurance provider to get approval, whether its for a service or for a medication. Usually, your physician will have a good idea of whether they need to get prior authorization.