Cigna Multiple Sclerosis PSC Prior Authorization Form 2020 free printable template

Fax completed form to: (855) 8401678 If this is an URGENT request, please call (800) 8824462 (800.88.CHINA)Multiple Sclerosis: Adagio,, ,, ,,, Latoya, Estrada, Maven clad, Payment, CRÉSUS, Pleurisy,,,

How to fill out Cigna Multiple Sclerosis PSC Prior Authorization

How to fill out Cigna Multiple Sclerosis PSC Prior Authorization Form

1. Obtain the Cigna Multiple Sclerosis PSC Prior Authorization Form from the Cigna website or your healthcare provider.
2. Complete the patient information section, including the patient's full name, date of birth, and member ID.
3. Provide the prescribing physician's details, including their name, contact information, and NPI number.
4. Detail the specific medication or treatment being requested for authorization.
5. Include medical history relevant to the treatment of Multiple Sclerosis, including prior medications and therapies.
6. Attach any necessary clinical documentation or test results that support the request.
7. Review the form for accuracy and completeness.
8. Sign and date the form, if required.
9. Submit the completed form to Cigna via the specified submission method (fax, email, or online portal).
10. Follow up with Cigna to confirm receipt and inquire about the authorization status.

Who needs Cigna Multiple Sclerosis PSC Prior Authorization Form?

1. Patients diagnosed with Multiple Sclerosis who require medication or treatment that necessitates prior authorization.
2. Healthcare providers who prescribe treatments for Multiple Sclerosis and need to obtain approval from Cigna for coverage.

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What is Cigna Multiple Sclerosis PSC Prior Authorization Form?

The Cigna Multiple Sclerosis PSC Prior Authorization Form is a document required by Cigna Health Insurance to obtain approval for coverage of specific multiple sclerosis treatments or medications before they are prescribed.

Who is required to file Cigna Multiple Sclerosis PSC Prior Authorization Form?

Healthcare providers, such as doctors or specialists treating patients with multiple sclerosis, are required to file the Cigna Multiple Sclerosis PSC Prior Authorization Form on behalf of their patients.

How to fill out Cigna Multiple Sclerosis PSC Prior Authorization Form?

To fill out the Cigna Multiple Sclerosis PSC Prior Authorization Form, the healthcare provider must complete patient information, treatment requested, relevant clinical information, and any additional documentation as specified by Cigna.

What is the purpose of Cigna Multiple Sclerosis PSC Prior Authorization Form?

The purpose of the Cigna Multiple Sclerosis PSC Prior Authorization Form is to ensure that the prescribed treatments or medications for multiple sclerosis are medically necessary and meet Cigna's criteria for coverage.

What information must be reported on Cigna Multiple Sclerosis PSC Prior Authorization Form?

The information that must be reported on the Cigna Multiple Sclerosis PSC Prior Authorization Form includes patient demographics, specific details about the treatment being requested, patient's medical history, and any prior therapies that have been attempted.