The Cigna Prior Authorization Form is required before Cigna approves coverage for certain prescription drugs, specialty medications, or medical services. Physicians submit the form on behalf of their patients to confirm medical necessity before treatment begins.
The form collects information across several key areas. The prescriber section requires the physician's name, NPI number, fax number, and office phone number. The patient section requires the Cigna member ID, date of birth, and primary diagnosis code. The treatment section specifies the medication or procedure requested, including dosage, strength, quantity, and clinical indication.
Cigna distinguishes between standard and urgent prior authorization requests. Urgent requests apply when delaying treatment could seriously jeopardize the patient's health. Standard prescription drug coverage requests are reviewed within five business days. Medical benefit requests may follow a different timeline.
Electronic submission is available through CoverMyMeds and SureScripts, which connect directly with pharmacy and hospital systems. Fax submission is also accepted using the fax number printed on the form. Cigna processes each request by reviewing the submitted clinical information against its coverage guidelines before issuing a determination.
| Question | Answer |
|---|---|
| Form Name | Cigna Prior Auth Form |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | cigna botox prior authorization form, cigna botox pa form, cigna botox form, cigna prior authorization form for botox |
