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Fill in Your Cigna Prior Auth Template

The Cigna Prior Authorization form is a crucial document used by healthcare providers to obtain approval for specific medications before they can be prescribed to patients. This form ensures that the requested medication is medically necessary and meets Cigna's coverage criteria. Timely submission of the form can help streamline the process, ultimately benefiting patient care.

Table of Contents

The Cigna Prior Authorization form is a critical tool for healthcare providers seeking approval for specific medications on behalf of their patients. This form facilitates the communication between physicians and Cigna, ensuring that necessary treatments are covered under a patient's insurance plan. Key sections of the form require detailed information about the physician and patient, including names, contact information, and Cigna ID numbers. The urgency of the request must also be indicated, allowing for expedited handling in cases where a patient's health is at risk. Essential details regarding the medication requested, such as its name, strength, dosing schedule, and the duration of therapy, must be clearly specified. Additionally, the form prompts providers to outline the patient's medical history, including previous medications and alternative treatments attempted, which helps establish the necessity of the requested drug. For those who prefer a more efficient approach, Cigna offers an online submission option, streamlining the process and reducing wait times. Understanding the components of this form is vital for ensuring timely and appropriate care for patients.

Sample - Cigna Prior Auth Form

Fax completed form to: (855) 840-1678

If this is an URGENT request, please call (800) 882-4462 (800.88.CIGNA)

Medication Prior

Authorization Form

PHYSICIAN INFORMATION

PATIENT INFORMATION

* Physician Name:

*Due to privacy regulations we will not be able to respond via fax

with the outcome of our review unless all asterisked (*) items on

Specialty:

* DEA or TIN:

this form are completed.*

Office Contact Person:

* Patient Name:

Office Phone:

* Cigna ID:

* Date of Birth:

Office Fax:

* Patient Street Address:

Office Street Address:

City:

State:

Zip:

City:

State:

Zip:

Patient Phone:

Urgency:

Standard

Urgent (In checking this box, I attest to the fact that applying the standard review time frame may

seriously jeopardize the customer’s life, health, or ability to regain maximum function)

Medication requested: (please specify name, strength, and dosing schedule)

Duration of therapy:

Quantity:

Diagnosis related to use:

[For pain medications only]: Does the patient have a terminal illness?

Yes

Alternative Medications:

Has your patient ever received the generic alternative of the requested medication?

Yes

No generic available

(if yes) Did your patient try more than one manufacturer of this generic?

Yes

Unavailable

Please provide the following details for each trial: manufacturer name, date(s) taken and for how long, and what the documented results were of taking the drug, including any intolerances or adverse reactions your patient experienced.

(please note that the manufacturer's information can be obtained through the dispensing pharmacy):

Drug Name	Dates taken & how long	Documented results, including intolerances/adverse
Drug Name	Dates taken & how long	reactions the patient experienced
		reactions the patient experienced




Has your patient ever received any other alternative treatments for this diagnosis?			Yes	No
(if yes) Please provide the following details: date(s) taken and for how long, and what the documented results were of taking
this drug, including any intolerances or adverse reactions your patient experienced:
Drug Name	Dates taken & how long	Documented results, including intolerances/adverse
Drug Name	Dates taken & how long	reactions the patient experienced
		reactions the patient experienced




(if no to any question above) Is your patient able to use any other alternatives for this diagnosis?			Yes	No

(if no) Please provide the reason(s) why your patient is unable to use the available alternative(s):

Additional pertinent information: (please include other clinical reasons for drug, relevant lab values, etc.)

Save Time! Submit Online at: www.covermymeds.com/main/prior-authorization-forms/cigna/ or via SureScripts in your EHR.

Our standard response time for prescription drug coverage requests is 5 business days. If your request is urgent, it is important that

you call us to expedite the request. View our Prescription Drug List and Coverage Policies online at cigna.com.

v091619

“Cigna" is a registered service mark, and the “Tree of Life” logo is a service mark, of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its operating subsidiaries. All products and services are provided by or through such operating subsidiaries and not by Cigna Corporation. Such operating subsidiaries include, for example, Cigna Health and Life Insurance Company and Cigna Health Management, Inc. Address: Cigna Pharmacy Services, PO Box 42005,

Phoenix AZ 85080-2005

↓ Cigna Prior Auth PDF

File Specs

Fact Name	Details
Submission Method	Fax the completed form to (855) 840-1678.
Urgent Requests	For urgent requests, call (800) 882-4462.
Privacy Regulations	All asterisked items on the form must be completed to receive a faxed outcome.
Patient Information Required	Patient's name, Cigna ID, date of birth, and address are required fields.
Medication Details	Specify the name, strength, and dosing schedule of the requested medication.
Response Time	The standard response time for requests is 5 business days.
Online Submission	Forms can be submitted online at www.covermymeds.com or via SureScripts.
Address for Cigna Pharmacy Services	Cigna Pharmacy Services, PO Box 42005, Phoenix AZ 85080-2005.

Cigna Prior Auth - Usage Guidelines

Completing the Cigna Prior Authorization form requires attention to detail to ensure that all necessary information is provided. Once the form is filled out, it should be faxed to the designated number. If the request is urgent, a phone call is the best way to expedite the process.

Begin with the Physician Information section. Fill in the following fields:

Physician Name
Specialty
DEA or TIN
Office Contact Person
Office Phone
Office Fax
Office Street Address
City
State
Zip

Next, move to the Patient Information section. Complete these fields:

Patient Name
Cigna ID
Date of Birth
Patient Street Address
City
State
Zip
Patient Phone

Indicate the Urgency of the request by checking either Standard or Urgent.
Fill in the Medication requested section. Specify the name, strength, and dosing schedule of the medication.
Provide the Duration of therapy and the Quantity needed.
Complete the Diagnosis related to use field, especially for pain medications.
Answer the question regarding whether the patient has a terminal illness by selecting Yes or No.
In the Alternative Medications section, indicate if the patient has ever received the generic alternative of the requested medication. Provide details if applicable.
If applicable, provide details for any other alternative treatments the patient has received, including dates and documented results.
Answer whether the patient is able to use any other alternatives for the diagnosis. If not, provide reasons.
Include any Additional pertinent information that may support the request, such as clinical reasons or relevant lab values.

Once all sections are complete, fax the form to (855) 840-1678. For urgent requests, it is advisable to call (800) 882-4462 to ensure swift processing.

Your Questions, Answered

What is the purpose of the Cigna Prior Authorization form?

The Cigna Prior Authorization form is used by healthcare providers to request approval for specific medications before they can be covered by Cigna insurance. This process ensures that the prescribed treatment is medically necessary and aligns with Cigna's coverage policies. By submitting this form, providers can help their patients access the medications they need in a timely manner.

How do I submit the Cigna Prior Authorization form?

You can submit the completed Cigna Prior Authorization form by faxing it to (855) 840-1678. If your request is urgent, it is advisable to call (800) 882-4462 for immediate assistance. Additionally, you have the option to submit the request online through www.covermymeds.com or via SureScripts in your Electronic Health Record (EHR) system.

What information is required on the form?

The form requires several key pieces of information, including the physician's name, specialty, and contact details, as well as the patient's name, Cigna ID, date of birth, and contact information. It is crucial to fill out all fields marked with an asterisk (*) to ensure a prompt response. Information about the medication requested, diagnosis, and any alternative treatments should also be included.

What is the standard response time for a prior authorization request?

The standard response time for prescription drug coverage requests is typically five business days. However, if the request is marked as urgent, Cigna encourages providers to call the designated number to expedite the review process. This can help ensure that patients receive their medications without unnecessary delays.

What should I do if my request is urgent?

If your request is urgent, you should call Cigna directly at (800) 882-4462. By doing so, you can communicate the urgency of the situation and potentially receive a faster decision regarding the prior authorization. This step is essential if delaying the treatment could seriously jeopardize the patient’s health or recovery.

What happens if the prior authorization is denied?

If a prior authorization request is denied, Cigna will provide an explanation for the denial. The healthcare provider can then discuss alternative options with the patient, which may include appealing the decision or considering other medications that do not require prior authorization. Understanding the reasons for denial can help in formulating a new plan of action.

Can patients access information about their medication coverage?

Yes, patients can view Cigna's Prescription Drug List and Coverage Policies online at cigna.com. This resource provides valuable information regarding which medications are covered and any specific requirements that may apply. Patients are encouraged to review this information to better understand their medication options and coverage.

Common mistakes

Incomplete Information: One of the most common mistakes is failing to fill out all the required fields marked with an asterisk (*). This includes essential details about both the physician and the patient. Omitting any of this information can delay the processing of the authorization request.
Incorrect Urgency Selection: Selecting the wrong urgency level can lead to significant delays. If the request is urgent, it’s crucial to check the "Urgent" box and provide justification. Misclassification can affect the patient's access to necessary medications.
Missing Documentation: Failing to provide detailed information about alternative medications and treatments can hinder the approval process. If a patient has tried other drugs, include the names, dates taken, and any adverse reactions. This information is vital for a thorough review.
Neglecting to Follow Up: After submitting the form, some individuals forget to follow up. It’s important to ensure that the request was received and is being processed. Calling the designated number can provide peace of mind and expedite the process if needed.

Documents used along the form

When submitting a Cigna Prior Authorization request, several other forms and documents may be necessary to support the process. Each document plays a crucial role in ensuring that the request is complete and has the best chance of approval. Below is a list of commonly used forms and documents that may accompany the Cigna Prior Auth form.

Medication History Report: This report provides a detailed history of the patient’s previous medications, including dosages and duration. It helps the reviewer understand the patient’s treatment journey.
Clinical Notes: These notes from the physician outline the patient's medical history and current condition. They provide context for the requested medication and support the need for prior authorization.
Lab Results: Relevant lab test results may be required to demonstrate the medical necessity of the requested medication. These documents can provide evidence of the patient’s diagnosis.
Specialist Consultation Notes: If a specialist is involved in the patient's care, their notes can offer additional insights into the treatment plan and the rationale for the medication request.
Previous Authorization Denials: If prior authorization for the same medication was denied, including this document can help clarify the reasons and show any changes in the patient’s condition.
Patient Consent Form: This form ensures that the patient has authorized the physician to share their medical information with Cigna for the prior authorization process.
Insurance Card Copy: A copy of the patient’s insurance card may be required to confirm coverage details and ensure the request is processed correctly.
Alternative Treatment Documentation: If alternative treatments were attempted, documentation of these trials, including results and reactions, can support the need for the requested medication.
Urgency Justification: If the request is marked as urgent, a brief explanation of the urgency may be required to expedite the review process.
Provider’s NPI Number: The National Provider Identifier (NPI) number of the prescribing physician may be necessary to verify their credentials and ensure compliance with healthcare regulations.

Gathering these documents can significantly enhance the efficiency of the prior authorization process. Ensuring that all necessary forms are completed and submitted can lead to quicker approvals and better patient outcomes. Act promptly to avoid delays in treatment.

Similar forms

The Cigna Prior Authorization form is similar to the Aetna Prior Authorization form. Both documents require detailed information about the patient and the requested medication. They focus on gathering the physician's information, patient demographics, and specifics about the medication, including dosage and duration. Each form also emphasizes the need for documentation of any previous treatments or alternative medications the patient may have tried. This ensures that the insurance company has a comprehensive understanding of the patient's medical history and the necessity of the requested treatment.

Another document similar to the Cigna Prior Authorization form is the UnitedHealthcare Prior Authorization form. Like Cigna's form, it collects essential information about the patient, including their insurance details and medical history. Both forms include sections for the physician to explain the urgency of the request and any relevant clinical information. This similarity helps streamline the approval process for medications and ensures that patients receive timely care based on their specific health needs.

The Blue Cross Blue Shield Prior Authorization form shares many characteristics with the Cigna form. Both documents require physicians to provide information about the patient's diagnosis and any alternative treatments attempted. They also ask for specific details about the medication, such as its strength and dosing schedule. This focus on thorough documentation helps facilitate a more efficient review process, allowing for quicker decisions on medication coverage.

Similarly, the Humana Prior Authorization form is akin to the Cigna form in its structure and purpose. Both forms aim to collect comprehensive information from healthcare providers regarding the patient's treatment plan. They ask for details about the patient’s medical history, previous medications, and the rationale for the requested treatment. This information is crucial for the insurance company to assess the necessity of the prescribed medication and to make informed coverage decisions.

Lastly, the Medicare Prior Authorization form also resembles the Cigna Prior Authorization form. Both documents require similar patient and physician information, including details about the requested medication and any prior treatment attempts. The emphasis on documenting clinical reasons and alternative therapies helps ensure that patients receive appropriate care while allowing insurers to evaluate requests based on medical necessity. This consistency across forms aids in maintaining a standardized approach to prior authorization processes in healthcare.

Dos and Don'ts

When filling out the Cigna Prior Authorization form, it's important to follow certain guidelines to ensure your submission is complete and accurate. Here’s a list of things you should and shouldn’t do:

Do provide all required information, especially the items marked with an asterisk (*). This ensures a timely response.
Do double-check the medication requested section. Include the name, strength, and dosing schedule clearly.
Do indicate the urgency of the request accurately. If it's urgent, be sure to call the provided number.
Do submit any additional pertinent information that may support the need for the medication.
Don't leave any sections blank. Missing information can delay the review process.
Don't forget to include details about any alternative medications your patient has tried. This information is crucial.
Don't submit the form without reviewing it for accuracy. Errors can lead to unnecessary complications.

By following these guidelines, you can help ensure a smoother authorization process for your patient’s medication needs.

Misconceptions

Misconceptions about the Cigna Prior Authorization form can lead to confusion and delays. Here are ten common misunderstandings, along with clarifications for each.

Only doctors can submit the form. Many people think only physicians can fill out and submit the Prior Auth form. However, authorized office staff can also complete and send it on behalf of the physician.
Fax is the only submission method. Some believe that faxing is the only way to submit the form. In fact, you can also submit it online through the Cigna website or via SureScripts in your EHR.
Urgent requests are always processed faster. While urgent requests are prioritized, they still require proper documentation. If the form is incomplete, it may delay the process.
All fields must be filled out to submit. It's a common belief that every section must be completed. Only the fields marked with an asterisk (*) are mandatory for processing.
Patients will be informed of the outcome via fax. Due to privacy regulations, Cigna cannot send the outcome of the review via fax unless all required fields are completed.
Once submitted, the process is automatic. Many assume that after submission, everything is taken care of. In reality, follow-up may be necessary if additional information is requested.
Generic alternatives are always available. Some people think that a generic version of every medication exists. This is not true, as some medications may not have a generic alternative.
All medications require prior authorization. Not every medication needs prior authorization. Check the Cigna Prescription Drug List to see which ones do.
Response times are the same for all requests. While the standard response time is 5 business days, urgent requests may receive faster responses if properly marked and documented.
Additional information is not necessary. Some believe that providing minimal information is sufficient. However, including detailed clinical reasons and relevant lab values can help expedite the review process.

Understanding these misconceptions can help streamline the prior authorization process and ensure timely access to necessary medications.

Key takeaways

Filling out the Cigna Prior Authorization form correctly is crucial for a smooth approval process. Here are key takeaways to keep in mind:

Complete All Required Fields: Ensure that all asterisked (*) items are filled out. Incomplete forms will delay the response.
Urgent Requests: For urgent requests, call (800) 882-4462 instead of relying solely on fax submissions.
Medication Details: Clearly specify the medication name, strength, and dosing schedule. This information is vital for the review process.
Alternative Medications: Provide details on any alternative medications your patient has tried, including manufacturer names and documented results.
Documented Results: Include any intolerances or adverse reactions the patient experienced with previous medications. This strengthens the case for the requested medication.
Online Submission: Save time by submitting the form online at www.covermymeds.com or through SureScripts in your EHR.
Standard Response Time: Expect a standard response time of 5 business days for prescription drug coverage requests. Urgent requests may be expedited by phone.
Additional Information: Include any other relevant clinical information, lab values, or reasons why alternatives may not be suitable for the patient.