Get Aetna Gr-69381-2 2018

Filling out the Aetna GR-69381-2 form for skilled home private duty nursing care can seem daunting, but with careful attention to detail, you can ensure a smooth submission process. This guide will provide you with step-by-step instructions to help you complete the form accurately.

Follow the steps to successfully complete the form.

1. Press the ‘Get Form’ button to access the Aetna GR-69381-2 form and open it in your editing tool.
2. Begin by filling out Section 1 with the required general information about the member, including their name, administrative reference number, member ID, date of birth, and the requesting provider's contact details.
3. In Section 2, provide patient-specific information. Indicate whether this is an initial request or an extension, and fill in the start date for skilled nursing care. Additionally, document the number of hours per day the patient requires nursing and the total number of visits requested.
4. Check the applicable options in Section 2 regarding the patient's condition, including their transition from an inpatient setting and if additional nursing care will prevent hospitalization. Describe the patient's home care needs and living situation in detail.
5. If applicable, complete Section 3 by stating the date the patient became dependent on a ventilator and the number of hours they are ventilator dependent each day.
6. For Section 4, gather and attach the necessary documentation, including the letter of medical necessity, physician orders, history and physical documents, and nursing assessment notes if it’s an extension request.
7. Carefully read Section 5, which outlines important information regarding fraudulent requests for insurance coverage.
8. Finally, in Section 6, ensure the form is signed by the treating doctor or qualified healthcare provider with the date, and include contact details for office personnel who can be reached for any further questions.
9. Once you have filled out the form and attached all necessary documents, submit it as instructed, either via electronic upload, fax, or mail as per the guidelines provided in the document.

Complete your Aetna GR-69381-2 form online to ensure your precertification request is processed swiftly and accurately.