Get Aetna Gr-69445-2 2019

Filling out the Aetna GR-69445-2 is an essential step for the precertification of whole exome sequencing. This guide provides clear instructions to help you navigate and complete this online form accurately.

Follow the steps to successfully complete the Aetna GR-69445-2 form.

1. Click ‘Get Form’ button to access the Aetna GR-69445-2 form and open it in your preferred online editor.
2. Begin with Section 1 by entering the administrative reference number along with the member's name, member ID, and date of birth. Make sure to provide complete and accurate details to prevent delays.
3. In Section 1, you will also fill in the requesting provider's information, including their name, NPI, phone number, and fax number. Additionally, provide the laboratory name, fax number, and date of specimen collection. Indicate whether the laboratory is participating or non-participating.
4. Proceed to Section 2 to outline the member's information and clinical history. Complete the criteria details, ensuring that you check all relevant boxes that are applicable to the member’s age and medical condition.
5. In Section 3, confirm that the member's and family history were assessed by a Board-Certified or Board-Eligible Medical Geneticist, and that the member received genetic counseling from an independent provider. Remember to attach the pre-test genetic consult with this request.
6. Complete Section 4 by stating that alternate etiologies were considered and ruled out. Ensure that the clinical presentation does not fit a well-known syndrome and provide justification for whole exome sequencing over single-gene tests.
7. In Section 5, specify how whole exome sequencing will influence health outcomes or medical decisions. This includes detailing potential treatments and impacts on clinical outcomes for the member.
8. In Section 6, fill out details for family trio testing if applicable, specifying the relation of the family members (mother, father, sibling) involved.
9. Review Section 7 for important information regarding the filing of claims and the implications of fraudulent submissions.
10. Finally, in Section 8, ensure the form is signed by the treating doctor or a qualified healthcare provider, entering the date of the signature. Also, provide contact name of office personnel for any queries along with their telephone number.
11. After completing the form, save your changes. You can then download, print, or share this form as necessary.

Take action now and complete the Aetna GR-69445-2 form online for a smooth precertification process.