
Get Aetna Prior Authorization Form
How it works
-
Open form follow the instructions
-
Easily sign the form with your finger
-
Send filled & signed form or save
How to fill out the Aetna Prior Authorization Form online
This guide provides a clear and comprehensive approach to completing the Aetna Prior Authorization Form online. By following these steps, you will ensure that all necessary information is accurately captured for efficient processing of your precertification request.
Follow the steps to complete your Aetna Prior Authorization Form effectively.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Begin by providing the patient information. Fill in the first name, last name, address, city, state, zip code, date of birth (DOB), and phone numbers including home and cell.
- Next, complete the insurance information section. Provide the Aetna Member ID number, group number, and indicate if the patient has Medicare or Medicaid, including relevant ID numbers.
- In the prescriber information section, enter the prescriber's first and last name, address, specialty, phone number, and email. It's also important to include the state license number and NPI number.
- Fill out the diagnosis information. Specify the primary ICD-9 code related to the patient’s condition and indicate whether the patient has confirmed bone metastases from solid tumors.
- Complete the prescription information section if Aetna Specialty Pharmacy is the dispensing provider. Enter the medication name, strength, directions, quantity, and refills.
- Finally, ensure that you have the prescriber’s signature and date it appropriately. Review all filled sections for accuracy before proceeding.
- Once you have completed the form, save your changes, download, print, or share the form as needed.
Start filling out your documents online today for a smooth experience!
To get prior authorization for Aetna, you should first consult your healthcare provider about the necessity of the procedure or service. They will fill out the Aetna Prior Authorization Form based on your specific needs. Make sure all information is accurate and complete to facilitate prompt approval. Utilizing US Legal Forms can also help you access the necessary documentation quickly and ensure you follow all required steps.
Fill Aetna Prior Authorization Form
Fax completed prior authorization request form to or submit Electronic Prior Authorization through. CoverMyMeds® or SureScripts. This form will help you supply the right information with your precertification request. Typed responses are preferred. Aetna has partnered with CoverMyMeds to offer electronic prior authorization (ePA) services. Select the appropriate Aetna form to get started. You can also print the required prior authorization form below and fax it along with supporting clinical notes to 1-.
Industry-leading security and compliance
-
In businnes since 199725+ years providing professional legal documents.
-
Accredited businessGuarantees that a business meets BBB accreditation standards in the US and Canada.
-
Secured by BraintreeValidated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.