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01. Edit your prior authorization form online
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Send prior auth now via email, link, or fax. You can also download it, export it or print it out.
How to use or fill out today's option prior auth forms with our platform
- Click ‘Get Form’ to open it in the editor.
- Begin by filling out the 'Provider Information' section. Enter your name, specialty, DEA or TIN, office contact person, and phone details.
- Next, complete the 'Patient Information' section. Ensure you provide all asterisked (*) items such as patient name, CIGNA ID, date of birth, and address.
- In the 'Medication Requested' field, select the appropriate Enbrel dosage and specify the duration of therapy along with any relevant J-Code.
- Indicate where the medication will be obtained by selecting from options like retail pharmacy or CIGNA Tel-Drug.
- For diagnosis related to use, check all applicable conditions such as Rheumatoid Arthritis or Psoriatic Arthritis.
- Finally, review all sections for completeness before submitting via fax at (800)390-9745. Ensure that all required fields are filled to avoid delays.
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