Get the free Coverage Determination Form Cigna-HealthSpring

Benita HCT Coverage Determination (FOR PROVIDER USE ONLY) MEMBER INFORMATION REQUIRED (Please Write Legibly) Customer Name:Customer ID:Customer DOB:Customer Address:Phone (Home):Phone (Cell):PROVIDER

How to fill out coverage determination form cigna-healthspring

How to fill out coverage determination form cigna-healthspring

1. To fill out the coverage determination form for Cigna-HealthSpring, follow these steps: 1. Gather all the necessary information: You will need the member's personal details including their name, date of birth, and contact information. You will also need their Cigna-HealthSpring policy number, doctor's information, and any relevant medical documentation.
2. Understand the reason for filling out the form: Make sure you have a clear understanding of why you are filling out the coverage determination form. This could be to request coverage for a specific medication, medical procedure, or service.
3. Complete the member information section: Fill out the member's personal details accurately, including their name, date of birth, and contact information. Double-check all the information to avoid any errors.
4. Provide Cigna-HealthSpring policy details: Enter the member's policy number and any other relevant policy information in the designated fields on the form.
5. Include doctor's information: Provide the name, contact information, and specialty of the doctor who prescribed or recommended the medication, procedure, or service for which you are seeking coverage.
6. Describe the medication, procedure, or service: Explain in detail why coverage is necessary. Include information about the specific medication, procedure, or service, its purpose, and any supporting medical documentation or test results.
7. Attach supporting documents: If there are any additional documents such as medical records, test results, or prior authorization forms, make sure to include them with the coverage determination form.
8. Review and submit the form: Double-check all the filled-out information, ensuring its accuracy and completeness. Once satisfied, submit the form to Cigna-HealthSpring as per their instructions. It is recommended to keep a copy of the completed form and supporting documents for your records.

Who needs coverage determination form cigna-healthspring?

1. Coverage determination forms from Cigna-HealthSpring are typically required by individuals who are existing policyholders and need to seek coverage for specific medications, procedures, or services.
2. This usually includes individuals who are prescribed medications that may require prior authorization or have restrictions in their coverage.
3. People who need certain medical procedures or services that may not be covered automatically by their policy or have limitations might also need to fill out a coverage determination form.
4. It is advisable to consult with Cigna-HealthSpring directly or review the policy terms and conditions to determine if a coverage determination form is necessary in specific situations.

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What is coverage determination form cigna-healthspring?

The coverage determination form cigna-healthspring is a form used to request a decision about coverage for a specific medical treatment or prescription drug.

Who is required to file coverage determination form cigna-healthspring?

Members or their healthcare providers are required to file the coverage determination form cigna-healthspring.

How to fill out coverage determination form cigna-healthspring?

The coverage determination form cigna-healthspring can be filled out online through the Cigna-HealthSpring website or by contacting customer service for assistance.

What is the purpose of coverage determination form cigna-healthspring?

The purpose of the coverage determination form cigna-healthspring is to determine if a specific medical treatment or prescription drug is covered by the member's insurance plan.

What information must be reported on coverage determination form cigna-healthspring?

The coverage determination form cigna-healthspring requires information such as the member's name, insurance ID, prescribing physician, diagnosis, and requested treatment or drug.