Get 1500 Form For Aetna 2020-2025

Filling out the 1500 Form For Aetna online is a straightforward process that helps ensure your prescription claims are processed effectively. This guide will walk you through each section of the form, providing clear and detailed instructions tailored to your needs.

Follow the steps to successfully complete your form.

1. Press the ‘Get Form’ button to access the 1500 Form For Aetna and open it in your preferred online editor.
2. Enter your Aetna member number at the top of the form, as your claim cannot be processed without it.
3. Fill in the group number if applicable and indicate if you are enrolled in Medicare by checking the relevant box.
4. Complete the employee's birthdate in the format MM/DD/YYYY, along with the employee's full name and address, including street, city, state, and zip code.
5. Input the company name and address related to your employment in the specified fields.
6. Sign the form where indicated under 'Employee Signature' and provide your telephone number.
7. In the section labeled 'Prescription(s) were for:', enter the details including the last name, first name, middle initial, gender, and birthdate of the patient receiving the prescription.
8. Indicate whether any family member's expenses are covered by another health plan or insurance. If yes, provide the necessary details including policy holder and insurance company information.
9. Specify the reason for manual filing of the claims by marking the appropriate options.
10. For each prescription, enter the required details including the date filed, Rx number, quantity, days supply, national drug code, medication name, strength, dosage form, prescriber’s name, and DEA number.
11. Attach detailed prescription receipts if available, as the claim cannot be processed without this information.
12. After completing all sections of the form, review your entries for accuracy.
13. Submit the finished form by mailing or faxing it to Aetna Pharmacy Management at the provided address or fax number.
14. Finally, consider saving a copy of your completed form for your records, and download or print it if needed.

Take the first step towards filing your claims by completing the 1500 Form For Aetna online today.