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Get Aetna Form Gr 68744
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How to use or fill out the Aetna Form Gr 68744 online
Filling out the Aetna Form Gr 68744 online is a straightforward process that ensures your precertification requests are submitted correctly. This guide will walk you through each section of the form with clear instructions, making it easy for you to provide accurate and complete information.
Follow the steps to complete the Aetna Form Gr 68744 online.
- Press the ‘Get Form’ button to access the form and open it in the designated editor.
- Fill in the patient information section (A). Include the patient's first and last name, address, city, state, ZIP code, home phone, work phone, cell phone, date of birth, allergies, email, current weight, and height.
- Proceed to section B for insurance information. Input the Aetna Member ID number, check if the patient has other coverage, and provide additional details as required.
- In section C, provide the prescriber information. Enter the prescriber's first and last name, their designation (M.D., D.O., N.P., P.A.), zip code, address, phone, fax, and other relevant identifiers such as UPIN, NPI, and DEA numbers.
- Section D requires you to indicate the diagnosis information. Provide the primary ICD-9 code and any other applicable codes.
- Complete section E, which involves clinical information. Answer questions about the patient's condition and treatment history. Indicate the drugs requested and provide relevant responses to symptom and therapy history.
- In section F, fill out the prescription information, including the medications requested, their quantities, and if they are to be dispensed by Aetna Specialty Pharmacy.
- Before submitting, review all entered information for accuracy. Save your changes, then download or print the completed form as needed.
Complete the Aetna Form Gr 68744 online to ensure your precertification requests are processed efficiently.
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To obtain prior authorization, start by gathering necessary documentation and the specific Aetna Form Gr 68744. You can then submit your request electronically or by phone. Always double-check that you've included all essential information to avoid delays and ensure a smoother approval process.
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