cigna procedure prior authorization template

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depending on a patient’s plan, you may be required to request a prior authorization or precertification for any number of prescriptions or services. to better serve our providers, business partners, and patients, the cigna coverage review department is transitioning from promptpa, fax, and phone coverage reviews (also called prior authorizations) to electronic prior authorizations (epas). if you are unable to use electronic prior authorization, you can call us at 1 (800) 882-4462 to submit a prior authorization request.

individual and family medical and dental insurance plans are insured by cigna health and life insurance company (chlic), cigna healthcare of arizona, inc., cigna healthcare of illinois, inc., and cigna healthcare of north carolina, inc. group health insurance and health benefit plans are insured or administered by chlic, connecticut general life insurance company (cglic), or their affiliates (see a listing of the legal entities that insure or administer group hmo, dental hmo, and other products or services in your state). life (other than gul), accident, critical illness, hospital indemnity, and disability plans are insured or administered by life insurance company of north america, except in ny, where insured plans are offered by cigna life insurance company of new york (new york, ny). for availability, costs and complete details of coverage, contact a licensed agent or cigna sales representative. cigna may not control the content or links of non-cigna websites.

a full list of cpt codes are available on the cignaforhcp portal . for medical services. description of service; start date of prior authorization request form–outpatient. please fax to: *procedure/ service requested: cpt code: hcpcs intended use: when an issuer requires prior authorization of a health care service, use this form to request the., cigna prior authorization form 2019, cigna prior authorization form 2019, cigna outpatient prior authorization form, cigna viscosupplementation prior authorization form, cigna prior authorization phone number.

generic fax request form. providers: you must get prior authorization (pa) for services before service is provided. please fax this form and supportive clinical to pre-cert department below by market:. prior authorization form for medical procedures, courses of treatment, or prescription drug benefits. if you have select medical services may require prior authorization to surgical procedures; durable medical equipment (dme) uses files in adobe acrobat portable document format (pdf)., cigna prior authorization number, cigna radiology prior authorization, cigna radiology prior authorization, cigna botox prior authorization form, cigna inpatient prior authorization form

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