Submit Precertification

Please submit this form for Lucent Health Care UR Precerts only
(not valid for Cigna precert).


To initiate precertification for a patient,
please fill out the form and attach medical documentation.

Thanks! Your form has been sent.

Our team will review and follow up with you as needed.

Uh-oh, something has gone wrong.

Your form couldn't be submitted at this time. Please try again later or contact us directly if the problem persists.

01Patient Data

02Referring Physician / Provider Data

03Provider / Facility Data

Choose Files