Get the free cigna vision claim form 2013

Cigna Vision Claim Form is a form to submit a claim for reimbursement of expenses related to vision care services. The form includes sections for providing personal and contact information, information about the services received, and any insurance or other coverage. The form must be completed and returned to Cigna for processing.

Cigna vision claim forms must be completed and filed by any individual or organization who has received vision care services and needs to submit a claim for reimbursement from Cigna.

The Cigna Vision Claim Form is used by members to submit a claim for reimbursement for vision care expenses. This form is used to submit claims for vision care services, eyeglasses, contact lenses, and other vision care products. The form can also be used to submit a claim for reimbursement for vision care expenses that are covered by a Cigna vision plan.

The following information must be reported on a Cigna Vision claim form: - Patient name - Patient address - Patient phone number - Patient date of birth - Patient ID number - Type of service (exam, contact lenses, glasses, etc.) - Date of service - Provider name - Provider address - Provider phone number - Provider NPI - Description of services provided - Diagnosis codes - Procedure code - Materials code - Fee charged - Copayment amount - Amount requested

Cigna does not have a set deadline for filing vision claim forms. It is recommended that you submit your claim as soon as possible to ensure timely processing.

To fill out a Cigna vision claim form, follow these steps: 1. Obtain the claim form: You can download the claim form from the Cigna website or contact their customer service to request a copy. 2. Provide personal information: Fill in your personal details, including your name, address, date of birth, and Cigna member ID. 3. Provide the patient information: If the patient is someone other than yourself, fill in their details, including their name and date of birth. 4. Choose the type of claim: Indicate whether the claim is for yourself (primary claim) or an additional claim to a primary submitted by someone else (secondary claim). 5. Describe the vision service: Provide information about the vision service received, such as an eye exam, glasses, contact lenses, or other vision-related expenses. 6. Attach supporting documents: Make sure to attach any necessary supporting documents to the form, such as receipts, itemized invoices, and a copy of your prescription. 7. Complete the provider section: If the vision service was performed by a healthcare provider, have them fill out their section on the form, including their name, address, phone number, and tax ID. 8. Sign and date the form: Sign and date the claim form to certify that the information provided is true and accurate. 9. Submit the claim: Send the completed claim form and supporting documents to Cigna using the address provided on the form. It is recommended to make a copy of the form for your records before submission. Remember to follow any specific instructions provided by Cigna regarding claim submission to ensure a smooth and timely processing of your vision claim.

Cigna does not explicitly state a penalty for late filing of vision claim forms on their website. However, it is always advisable to file claims promptly to ensure timely processing and reimbursement. It is best to contact Cigna directly or review your specific policy terms and conditions to determine any potential penalties or consequences for late filing.