Get Aetna Prior Auth Form

Filling out the Aetna Prior Auth Form is an essential step in obtaining precertification for the medication (). This guide will provide you with clear instructions to help you complete the form online accurately and efficiently.

Follow the steps to complete the Aetna Prior Auth Form online.

1. Click ‘Get Form’ button to access the Aetna Prior Auth Form and open it in your preferred document editor.
2. Fill in the start date for treatment and the date of last treatment. Make sure to complete all specified fields for a thorough review.
3. In the Patient Information section, provide details such as the patient's first and last name, address, date of birth, current weight and height, and contact information including phone numbers and email, ensuring each field is legible.
4. In the Insurance Information section, include the Aetna member ID number, group number, and indicate whether the patient has additional insurance coverage. If they do, provide the necessary ID details.
5. Complete the Prescriber Information section with the prescriber's name, NPI number, and specialty, choosing from the list provided. Make sure to check the appropriate professional designation.
6. Fill out the Dispensing Provider/Administration Information, indicating where the medication will be administered and providing the necessary contact information for the dispensing provider.
7. In the Product Information section, specify that the request is for and include details about the dose and frequency.
8. Complete the Diagnosis Information by providing the primary ICD-9 code for the condition being treated and any secondary codes as applicable.
9. Address the Clinical Information requirements, answering all questions regarding the patient's condition and previous treatments. This section is crucial for a complete precertification request.
10. Finally, ensure your acknowledgment is signed and dated. Review the document for completeness and accuracy before submission.
11. Once all information has been filled out, you can save your changes, download, print, or share the form as needed.

Start filling out the Aetna Prior Auth Form online today to ensure a smooth precertification process.