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Cigna direct deposit form 2026
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- Click ‘Get Form’ to open the Cigna Direct Deposit Authorization Form in the editor.
- Begin by entering your Legal Entity Name, ensuring it matches the Tax Identification Number (TIN) associated with your practice.
- Fill in your Billing Address, including Street, City, State, and Zip Code. This information is crucial for accurate processing.
- Provide a Contact Name along with their Telephone number and Email Address for any follow-up regarding the form.
- Select the Type of Request by checking one of the options: Cancellation, Enrollment, or Change.
- Input your Bank Account Number and Bank Routing Number. Ensure these numbers are correct to avoid delays.
- Indicate the Type of Account by checking either Business Checking Account, Business Savings Account, or Other.
- Sign and date the form at the bottom to authorize Cigna to process your direct deposits.
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