Get Aetna Referral Form

Filling out the Aetna Referral Form online is a straightforward process that helps facilitate necessary referrals for medical services. This guide provides clear instructions to assist users in completing the form accurately and efficiently.

Follow the steps to complete the form with ease.

1. Press the ‘Get Form’ button to access the form and open it in your preferred editing platform.
2. Indicate the urgency of the referral by selecting one of the options: 'Priority' or 'Routine'. If the referral is for AARP Medicare Complete or any additional plans, select those accordingly.
3. In the 'Patient Information' section, fill in the patient's name, gender, date of birth, and insurance details. If there is other insurance coverage, indicate 'Yes' and provide the name of the other carrier.
4. Provide the patient’s address and daytime phone number. In the event of an accident, mark 'Yes' or 'No' for job-related incidents and indicate if it is a result of a motor vehicle accident.
5. Complete the 'Referring Primary Care Physician Information' section by filling out the name of the primary care physician (PCP) and ensuring to include contact information.
6. In the 'Referred to (Specialist) Information' section, enter the specialist's name and check if referring to specific services such as a Diabetes Care Center or Cardiac Rehab.
7. Fill in the diagnosis and the corresponding ICD-10 code. Specify the date of request and number of visits authorized, ensuring to choose the correct referral type based on the patient's needs.
8. Attach any required medical records and documents, such as progress notes, lab reports, or imaging studies, to ensure the referral is processed without delays.
9. Before submitting, ensure all information is accurate and complete. You can save changes, download, print, or share the completed form as needed.

Begin filling out the Aetna Referral Form online to streamline your referral process.