Cigna dental specialty referral form 2025

1. Click ‘Get Form’ to open the Cigna Dental Specialty Referral Form in the editor.
2. Begin by entering the 'Date of Referral' at the top of the form. This is essential for tracking purposes.
3. Fill in the 'Patient Information' section, including the patient's name and date of birth. Ensure accuracy as this information is critical for identification.
4. In the 'Carrier Information' section, provide details such as your member number and contact information. This helps streamline communication with Cigna.
5. Complete the 'Primary or Requesting Dentist' section by entering their name, specialty, and provider ID. This identifies who is referring the patient.
6. Next, fill out the 'Specialist Dentist' section with similar details about the specialist you are referring to.
7. In 'Referral Information', specify the reason for referral and any relevant medical history or test results that may assist in treatment.
8. Indicate services desired and complete any additional sections like teeth diagrams or place of service as needed.
9. Finally, ensure all signatures are completed before submitting. Review all entries for accuracy to avoid delays in processing.

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