Home
Forms Library
Cigna medical request form

Cigna disability management solutions medical request form 2025

cigna medical request form Preview on Page 1

See details

4.4 out of 5

42 votes

The document is a medical request form from CIGNA Group Insurance for evaluating a patient's disability claim. It includes sections for the physician to provide details about the patient's diagnosis, treatment history, current medications, and any restrictions affecting their ability to return to work. The form emphasizes the importance of submitting supporting reports and documentation to avoid delays in claim determination.

Here's how it works

01. Edit your cigna medical request form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

How to quickly redact Cigna disability management solutions medical request form online

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Dochub is the greatest editor for changing your paperwork online. Adhere to this simple instruction to edit Cigna disability management solutions medical request form in PDF format online at no cost:

Register and log in. Register for a free account, set a strong password, and proceed with email verification to start working on your templates.
Add a document. Click on New Document and choose the form importing option: upload Cigna disability management solutions medical request form from your device, the cloud, or a protected link.
Make changes to the template. Use the top and left panel tools to edit Cigna disability management solutions medical request form. Add and customize text, images, and fillable fields, whiteout unneeded details, highlight the important ones, and provide comments on your updates.
Get your paperwork accomplished. Send the sample to other individuals via email, create a link for faster document sharing, export the template to the cloud, or save it on your device in the current version or with Audit Trail included.

Explore all the advantages of our editor today!

be ready to get more

Complete this form in 5 minutes or less

Get form

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.

What is the CPT code for Cigna EAP?

Cigna requires: Use the CPT Code 99404 in order to indicate the sessions is billed under EAP.

What number is 1 800 244 6224 Cigna?

Call us at 1 (800) 244-6224 or at the toll-free telephone number for mental health/substance abuse services on your ID card. The hearing impaired may call the California Relay Service dialing 711. If you prefer, you can print and complete our Medical GRIEVANCE FORM: English [PDF] | Spanish [PDF] | Chinese [PDF].

How to file a medical claim with Cigna?

To submit a medical, dental, or mental health claim: Download and print the appropriate claim form (depending on the type of claim) Follow the instructions included on the form to complete it. Mail your completed claim to the address shown on the form.

How to submit an EAP claim?

EAP claims should be submitted through Provider Express or on a CMS-1500 claim form using the standard HJ modifer in section 24D.

What is a Cigna AOR form?

Appointment of Authorized Representative Form. You may represent yourself, or you may ask another person, including your treating health care provider, to act as your authorized representative. You may revoke this authorization at any time.

How to submit a Cigna EAP claim?

For all EAP sessions (including SAP referrals), you should submit your claims utilizing the CPT code 99404. Claims must be submitted with the correct/current ICD-10-CM Diagnosis codes. Claims submitted with outdated or incomplete diagnosis codes will be denied.

Can I submit a Cigna claim electronically?

Submitting medical, dental, and behavioral claims electronically can help you save time, money, and improve claim processing accuracy. Using one of Cignas electronic data interchange (EDI) options allows you to send, view, and track claims no faxing, printing, or mailing.

Cigna disability management solutions medical request form 2025

Here's how it works