Download the correct form from the Cigna website. Ensure you have the most recent version.
Carefully read all instructions. Pay close attention to required fields and deadlines.
- Patient Information: Double-check accuracy of name, date of birth, address, and insurance ID. Prescriber Information: Verify the prescribing physician’s name, contact information, NPI number, and signature. Diagnosis: Provide the correct ICD-10 code for the diagnosed condition justifying Viagra use. Inaccurate codes cause delays. Treatment Plan: Clearly state the proposed dosage, frequency, and duration of Viagra treatment. Be specific. Prior Authorization History: If previous authorizations exist, include that information.
Complete all sections fully and legibly. Use black ink; avoid smudges or corrections.
Gather Supporting Documentation: Include all necessary clinical records, supporting the need for Viagra. This may include lab results, medical history, and previous treatment attempts. Submit the Form: Submit the completed form and all supporting documents via the designated method (fax, mail, or online portal). Keep a copy for your records. Follow Up: After submission, track the status of your prior authorization request. Contact Cigna if you don’t receive an update within the timeframe specified on the form.
Contact Cigna’s customer service if you encounter any problems or have questions about completing the form. They can clarify any uncertainties.
