Get the free cigna dental claim form

Dental Claim Form HEADER INFORMATION 1. Type of Transaction (Mark all applicable boxes) Statement of Actual Services EPS DT/ Title XIX 2. Predetermination / Preauthorization Number Request for Predetermination

How to fill out cigna dental claim form

How to fill out cigna dental claim form:

1. Gather necessary information: Before filling out the form, gather all the required information, such as the policyholder's name and Cigna ID number, the dental provider's information, and details about the dental treatment or service received.
2. Complete the claimant section: Start by providing your personal information in the claimant section. This includes your name, address, phone number, and policyholder relationship (if applicable).
3. Include policy information: Fill in the policyholder's name, Cigna ID number, and group number. This information is essential for processing the claim correctly.
4. Provide provider details: Enter the dental provider's information, including their name, address, phone number, and tax identification number. Make sure to double-check the accuracy of these details.
5. Describe the service: Indicate the date of the dental service and provide a description of the treatment or service received. Be specific and include any relevant codes or descriptions provided by the dentist.
6. Attach necessary documents: If there are any supporting documents required, such as itemized bills or receipts, make sure to attach them securely to the claim form.
7. Review and sign: Before submitting the form, carefully review all the information provided to ensure accuracy. Once reviewed, sign and date the form.
8. Submitting the claim: You can submit the filled-out claim form and any supporting documents through various methods, such as mailing it to the provided address or submitting it electronically through Cigna's online portal.

Who needs cigna dental claim form:

1. Policyholders: Any individual covered by a Cigna dental insurance policy who has received dental services and wants to request reimbursement for those services will need to fill out the Cigna dental claim form.
2. Dependents: If any dependents covered under the policy have utilized dental services, the policyholder will need to fill out the claim form on their behalf.
3. Dental providers: In some cases, dental providers may also need to fill out sections of the claim form, such as providing their information and details of the services rendered when submitting claims directly to Cigna on behalf of their patients.

People Also Ask about

Can I submit a dental claim online Cigna?

Submitting medical, dental, and behavioral claims electronically can help you save time, money, and improve claim processing accuracy. Using one of Cigna's electronic data interchange (EDI) options allows you to send, view, and track claims – no faxing, printing, or mailing. Everything is right on your desktop.

What is the timely filing limit for a corrected claim Cigna 2022?

As a Cigna-HealthSpring contracted provider, you have agreed to submit all claims within 120 days of the date of service.

How long after denial can you file timely Cigna?

Your first appeal must be initiated within 180 calendar days of the date of initial payment or denial. Appeal decisions are made within 30 days of receipt by CIGNA and written notification of the decision is sent to you via letter or EOP. Time periods are subject to applicable law and the Provider Agreement.

How do I file a reimbursement claim with Cigna?

To submit a medical, dental, or mental health claim: Download and print the appropriate claim form (depending on the type of claim) Follow the instructions included on the form to complete it. Mail your completed claim to the address shown on the form.

What is the payer ID for Cigna Dental claims?

Yes. Dental offices can electronically submit all claims and encounters at the same time. Just be sure that you are using the correct Payer ID – 62308.

What is the timely filing limit for Cigna claim 2022?

The claim must be received within 120 days from date of service to be considered timely.

For pdfFiller’s FAQs

Where do I find cigna dental claim form?

It’s easy with pdfFiller, a comprehensive online solution for professional document management. Access our extensive library of online forms (over 25M fillable forms are available) and locate the cigna dental claim form in a matter of seconds. Open it right away and start customizing it using advanced editing features.

Can I create an electronic signature for the cigna dental claim form in Chrome?

Yes. With pdfFiller for Chrome, you can eSign documents and utilize the PDF editor all in one spot. Create a legally enforceable eSignature by sketching, typing, or uploading a handwritten signature image. You may eSign your cigna dental claim form in seconds.

How do I fill out cigna dental claim form on an Android device?

On an Android device, use the pdfFiller mobile app to finish your cigna dental claim form. The program allows you to execute all necessary document management operations, such as adding, editing, and removing text, signing, annotating, and more. You only need a smartphone and an internet connection.

What is cigna dental claim form?

The Cigna dental claim form is a document used by patients or dental care providers to submit a claim for dental services covered under a Cigna dental insurance plan.

Who is required to file cigna dental claim form?

Typically, the dental care provider files the Cigna dental claim form on behalf of the patient; however, patients can also file it if necessary.

How to fill out cigna dental claim form?

To fill out the Cigna dental claim form, you must provide patient information, details about the dental services rendered, the provider's information, and any relevant insurance information.

What is the purpose of cigna dental claim form?

The purpose of the Cigna dental claim form is to facilitate the reimbursement process for dental services by providing necessary details to the insurance company.

What information must be reported on cigna dental claim form?

The information that must be reported includes patient details, insurance policy numbers, procedure codes, dates of service, and the total amount charged for the services.