IMPORTANT: This claim form is intended for subscribers and covered dependents who receive services from providers outside the Cigna Vision network. If your plan permits a non-participating provider to accept assignment, the provider must submit a completed CMS-1500 form (also known as a HCFA-1500 form) to Cigna Vision at the address below. One claim form can be used to request up to three expenses. Box 182223, Chattanooga, TN 37422-7223 endstream
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Prior Authorizations; See instructions at the end of the form. If none, leave blank.) Even if not part of the Cigna network (out-of-network), your health care professional still can file the claim for you. %PDF-1.6
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Cigna makes it easy for health care providers to submit claims, with EDI vendors and easy clean claim requirements. �.�w``�e������~��A��������j�0�``���/H�,�8^ _Q�0hr�w<2A\�ɇ8�>o�@K��6�&���d`ʼ��������Eo_����:j�V����F9/���W��ؠp�������;�.�Nә�.�`��U"��fZ�d�/p*x�X�w�^�L�%��,*&3w h$ �g`ݺH���DZ#�)mg5k�؊��Z)/&.�k����)x8,�
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Please return your completed claim form to: For claim forms outside the USA: Cigna Global Health Benefits, 1 Knowe Road, Greenock, Scotland, PA15 4RJ Tel: +44 (0) 1475 492197 Fax: +44 (0) 1475 492424 E-mail address: ice.team@cigna.com For claim forms in the USA: Cigna Global Health Benefits, PO Box 15050, Wilmington, DE 19850-5050 USA Mail your completed claim form(s), with original itemized bill(s) attached, to the Cigna HealthCare Claims Office printed on your Cigna HealthCare ID card. �B��������p 512 0 obj
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As a leading Third Party Administrator covering the UAE region, Neuron provides expert business solutions to the Health insurance market. Download. Dental Claim Form. If you received this claim form electronically, click to the right of … 321 0 obj
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