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How to fill out the Aetna GC-464 online
Filling out the Aetna GC-464 form is an essential step for individuals seeking medical or behavioral health coverage evaluations. This guide provides clear, step-by-step instructions to ensure accurate completion of the form, facilitating a smooth submission process.
Follow the steps to conveniently fill out the Aetna GC-464 online
- Press the ‘Get Form’ button to access and open the Aetna GC-464 form in your online editor.
- Section 1: Employer information. Input the name exactly as it appears on the ID card and the policy or group number.
- Section 2: Employee information. Fill in your name, ID number, and birth date in the format MM/DD/YYYY.
- Section 3: Dependent child information. Provide the name and birth date of the dependent child, ensuring to use the MM/DD/YYYY format.
- Section 4: Physician’s statement. For medical conditions, complete section A, including diagnosis, date of onset, objective findings, and any additional clinical information for individuals over 18. For behavioral health conditions, complete sections A and B, which include the individual's IQ score and a functional assessment.
- In section C, refer to the Social Security disability guidelines to determine and document the individual’s affected body systems and any applicable listing numbers. Remember to include any relevant medical records.
- Section 5: Fill in the attending physician's contact information, including their name, phone number, address, and signature, along with the date.
- Section 6: List other treating physicians or healthcare providers who are involved in the care of the individual for their mental or physical disability.
- Finally, review all entries for accuracy. Once completed, you can save changes, download, print, or share the form as needed.
Complete the Aetna GC-464 online today to ensure timely processing of your medical or behavioral health claims.
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The group ID number is usually found on the front of your Aetna insurance card, next to your member ID. If you are having trouble locating it, check the documentation you received when you enrolled. You can also access your group ID through the Aetna online portal or by contacting their customer service. Being familiar with your Aetna GC-464 group ID can simplify your healthcare transactions.