Get Aetna Claim Form 2011-2026

This guide provides clear and supportive instructions on how to effectively fill out the Aetna Claim Form online. By following these steps, users can ensure that they complete the form accurately and submit it without delays.

Follow the steps to fill out the Aetna Claim Form online.

1. Click ‘Get Form’ button to access the Aetna Claim Form and open it in your preferred editor.
2. Fill in your Aetna ID Number. This information is essential as the claim cannot be processed without it.
3. Enter the member's name, including first, middle, and last names. Ensure all names are spelled correctly.
4. Select the member's gender by marking either ‘Male’ or ‘Female’.
5. Complete the member's address, including street, city, state, and zip code.
6. Provide the member's birthdate in the format MM/DD/YYYY.
7. Enter the member's telephone number. This is important for communication regarding the claim.
8. State the reason for manually filing the claims. Choose from options such as Coordination of Benefits, not receiving the Aetna ID card, or pharmacy issues.
9. If applicable, provide a description of an emergency situation that necessitated manual claim submission.
10. Fill out the pharmacy information, ensuring all sections are completed. Attach detailed prescription receipts or request your pharmacist to complete the necessary fields.
11. For each prescription, enter the date filed, Rx number, quantity, and national drug code. Specify if it is a new medication or a refill.
12. Input the medication name, strength, and dosage form. Include the doctor's name and DEA number.
13. Mark the DAW (Dispense as Written) field appropriately, and provide the RX price, including any tax.
14. Ensure that a signature from the pharmacist is included, confirming that all information provided is accurate.
15. Review the entire form for completeness and accuracy. Use separate forms for multiple pharmacies.
16. Mail the completed Aetna Prescription Drug Claim Form to Aetna Pharmacy Management, Attn: Medicare Processing, P.O. Box 14023, Lexington, KY 40512-4023.

Begin your claim process today by filling out the Aetna Claim Form online.