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How to fill out the Aetna Referral Form online
Filling out the Aetna Referral Form online is a straightforward process designed to streamline the medication precertification request. This guide provides step-by-step instructions to ensure that all necessary information is accurately submitted.
Follow the steps to complete the Aetna Referral Form online effectively.
- Click ‘Get Form’ button to access the Aetna Referral Form and open it in your preferred online editor.
- Begin by entering the patient information in section A. Fill out the first name, last name, address, date of birth, and contact details, including phone and email. Ensure to provide accurate information to avoid processing delays.
- In section B, input the insurance information. This includes the Aetna member ID, group number, and details about any other insurance coverage the patient may have.
- Proceed to section C to provide the prescriber information. Enter the prescriber's first and last name, address, contact numbers, and specialty.
- Move to section D to identify the diagnosis. Be sure to provide the appropriate ICD-9 codes as necessary.
- In section E, respond to the clinical information queries that apply to the patient's condition. Indicate any relevant medical diagnoses, including the specifics related to the requested therapy.
- If the Aetna Specialty Pharmacy is the dispensing provider, complete section F with prescription information. Fill out medication names, strengths, and directions clearly for the pharmacy’s reference.
- Review all sections to ensure all fields are accurately filled. Upon confirming the information, save changes, download the completed form, or share it as necessary.
Begin filling out the Aetna Referral Form online today to expedite your medication precertification request.
To fill an Aetna Referral Form effectively, collect the required data and follow the structured format provided. Input the patient’s information, the referring doctor’s details, and specifics about the referral reason. Clear and concise entries will not only assist in the swift processing of the referral but also enhance communication with the specialist.
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