Cigna direct deposit form 2026

1. Click ‘Get Form’ to open the Cigna Direct Deposit Authorization Form in the editor.
2. Begin by entering your Legal Entity Name, ensuring it matches the Tax Identification Number (TIN) associated with your practice.
3. Fill in your Billing Address, including Street, City, State, and Zip Code. This information is crucial for accurate processing.
4. Provide a Contact Name along with their Telephone number and Email Address for any follow-up regarding the form.
5. Select the Type of Request by checking one of the options: Cancellation, Enrollment, or Change.
6. Input your Bank Account Number and Bank Routing Number. Ensure these numbers are correct to avoid delays.
7. Indicate the Type of Account by checking either Business Checking Account, Business Savings Account, or Other.
8. Sign and date the form at the bottom to authorize Cigna to process your direct deposits.

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