Get Aetna Appeal Form 2020-2025

Filing an appeal with Aetna can be a straightforward process when you have the right guidance. This guide provides clear, step-by-step instructions to help you fill out the Aetna Appeal Form online with ease.

Follow the steps to complete the Aetna Appeal Form accurately

1. Click the ‘Get Form’ button to access the appeal form and open it in your preferred editor.
2. Enter today's date in the designated field.
3. Provide the member's ID number, which can be located on the front of the member's ID card.
4. Select the plan type, choosing either Medical or Dental as appropriate.
5. Fill in the member's first and last name.
6. Optionally, include the member's group number if applicable.
7. Provide the member's birthdate in the format MM/DD/YYYY.
8. Insert the provider's name and Tax Identification Number (TIN) or National Provider Identifier (NPI).
9. If applicable, include the provider group name.
10. Fill out the contact name and title for correspondence.
11. Enter the contact address where the appeal or complaint resolution should be sent.
12. Provide a contact phone number, fax number, and email address for follow-up.
13. To assist Aetna in processing your request, provide the claim ID number(s) and reference or authorization number.
14. Include the initial denial notification date and the service date.
15. If applicable, provide the reconsideration denial notification date.
16. List the CPT/HCPC/service being disputed.
17. In the explanation section, describe your request clearly. Feel free to use additional pages if necessary.
18. Gather and attach any supporting documents, such as medical records, that bolster your dispute.
19. Finally, review your form for accuracy, then save the changes. You can choose to download, print, or share the completed form as needed.

Complete your appeal documents online today for a smooth submission process.