Cigna IVIG-SCIG PSP Prior Authorization Form 2016 free printable template

IVG (Intravenous Immune Globulin) SCI (Subcutaneous Immune Globulin) Phone: (800) 2446224 Fax: (855) 8401678 Notice: Please be sure to complete this form in its entirety. Missing information makes

How to fill out Cigna IVIG-SCIG PSP Prior Authorization Form

How to fill out Cigna IVIG-SCIG PSP Prior Authorization Form

1. Obtain the Cigna IVIG-SCIG PSP Prior Authorization Form from the Cigna website or your healthcare provider.
2. Fill in the patient's personal information, including name, date of birth, and insurance details.
3. Provide the physician's information, including name, practice name, and contact details.
4. Indicate the diagnosis that requires IVIG or SCIG treatment in the designated section.
5. List the specific medication(s) requested, including dosage and frequency.
6. Include any relevant medical history or previous treatments related to the condition.
7. Attach any supporting documentation such as lab results or letters of medical necessity.
8. Review the form for completeness and accuracy.
9. Submit the completed form and supporting documents through the indicated method (fax, online portal, etc.).
10. Follow up with Cigna to confirm receipt and check the status of the authorization.

Who needs Cigna IVIG-SCIG PSP Prior Authorization Form?

1. Patients requiring treatment with intravenous immunoglobulin (IVIG) or subcutaneous immunoglobulin (SCIG), as prescribed by their healthcare provider.
2. Individuals with certain autoimmune disorders, primary immunodeficiency diseases, or other conditions that necessitate immunoglobulin therapy.

People Also Ask about

How long does prior approval take?

This is known as 'prior approval' and it's likely you'll need to submit an application early on to see whether or not your project warrants this type of planning. Time required: on average, 8 weeks.

Does Cigna cover Xarelto?

Cigna covers rivaroxaban tablets and oral suspension (Xarelto®) as medically necessary when the following criteria are met for FDA Indications or Other Uses with Supportive Evidence: Prior Authorization is recommended for prescription benefit coverage of Xarelto.

What is the electronic payer ID for Cigna Medicare Supplement?

Just be sure that you are using the correct Payer ID – 62308.

What is a Tier 3 drug mean?

Tier 1: Least expensive drug options, often generic drugs. Tier 2: Higher price generic and lower-price brand-name drugs. Tier 3: Mainly higher price brand-name drugs. Tier 4: Highest cost prescription drugs.

Does Cigna have a separate prescription card?

No, you'll get one ID card for both your pharmacy and medical needs. to remember about your new ID card: 1. Use your new Cigna ID card every time you fill a prescription.

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What is Cigna IVIG-SCIG PSP Prior Authorization Form?

The Cigna IVIG-SCIG PSP Prior Authorization Form is a document required by Cigna to obtain approval for intravenous immunoglobulin (IVIG) or subcutaneous immunoglobulin (SCIG) therapy through their Patient Support Program (PSP).

Who is required to file Cigna IVIG-SCIG PSP Prior Authorization Form?

Healthcare providers prescribing IVIG or SCIG therapy for patients covered by Cigna are required to file the Cigna IVIG-SCIG PSP Prior Authorization Form.

How to fill out Cigna IVIG-SCIG PSP Prior Authorization Form?

To fill out the Cigna IVIG-SCIG PSP Prior Authorization Form, healthcare providers must provide patient information, insurance details, medical history, diagnosis, and the specific treatment plan including dosage and frequency of administration.

What is the purpose of Cigna IVIG-SCIG PSP Prior Authorization Form?

The purpose of the Cigna IVIG-SCIG PSP Prior Authorization Form is to ensure that the requested treatment is medically necessary and appropriate for the patient, and to facilitate the approval process for coverage of IVIG or SCIG therapy.

What information must be reported on Cigna IVIG-SCIG PSP Prior Authorization Form?

The information that must be reported on the Cigna IVIG-SCIG PSP Prior Authorization Form includes patient demographics, insurance information, diagnosis codes, treatment history, prescribed therapy details, and any supporting clinical documentation.