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Get Aetna Better Health Of Illinois Prior Authorization Request Form Phone: 1-866-212-2851 (icp) Or
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How to fill out the AETNA BETTER HEALTH OF ILLINOIS Prior Authorization Request Form Phone: 1-866-212-2851 (ICP) Or online
Filling out the AETNA BETTER HEALTH OF ILLINOIS Prior Authorization Request Form is an important step in ensuring that users receive the necessary care. This guide will walk you through the process, providing clear and supportive instructions for each section of the form.
Follow the steps to complete the form accurately and efficiently.
- Press the ‘Get Form’ button to access the Prior Authorization Request Form and open it in the appropriate editor.
- Enter the date of the request in the designated field. This information is important for tracking the request timeline.
- Fill out the member information section including the member's name, ID number, date of birth, and primary care provider (PCP) name. If the member has other insurance, provide the policy holder's name and policy number as well.
- In the provider information section, complete the details for both the ordering/requesting provider and servicing provider/facility/specialist. Ensure to include the names, National Provider Identifiers (NPIs), addresses, telephone numbers, fax numbers, and contact person, as these fields are required.
- Provide the authorization information including the diagnosis using the required ICD-9 codes. You can include multiple codes if necessary.
- List the service or procedure requested by entering the required CPT or HCPCS codes. This section can include multiple entries as well.
- Indicate the type of procedure or level of care by selecting one of the following options: inpatient, outpatient, or in-office.
- Specify the date(s) of service being requested and the number of visits or units that are expected.
- Attach all required documentation that supports the clinical information related to the request, ensuring that it does not exceed five pages. This may include clinical notes, lab results, and letters of medical necessity.
- Review all provided information for accuracy and completeness, as failure to include necessary information will result in the form being returned unprocessed.
- Once completed, save your changes, and you can choose to download, print, or share the form as needed.
Start filling out your AETNA BETTER HEALTH OF ILLINOIS Prior Authorization Request Form online today.
To ask for prior authorization, you need to complete the AETNA BETTER HEALTH OF ILLINOIS Prior Authorization Request Form accurately. Once your form is ready, submit it through the relevant channels suggested by Aetna. If you need further clarification, contacting Aetna Better Health at 1-866-212-2851 (ICP) can help guide you through the process.
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