Get Aetna Better Health Of Ky Form

This guide provides clear instructions for completing the Aetna Better Health Of Ky Form online. Whether you are a provider or a representative, this user-friendly approach ensures a smooth and efficient process for submitting your appeal.

Follow the steps to complete the form online:

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Fill in the provider name at the designated section, ensuring that the name accurately reflects the entity submitting the appeal.
3. Enter the member name in the space provided, ensuring that the individual’s name aligns with the records.
4. Provide the member's date of birth (DOB) by selecting or typing the correct date in the appropriate format.
5. Document the date of service for the claim in question, ensuring it corresponds with the service rendered.
6. Include the provider National Provider Identifier (NPI), if applicable, to identify your practice.
7. Input the member ID number to help link the appeal with the patient's health record.
8. State the claim number associated with the appeal for accurate tracking.
9. Specify the amount billed, ensuring that the figures are precise and reflect the service charges.
10. Detail the nature of your appeal in the provided space, citing relevant information and attaching any supplemental documents if necessary.
11. Identify the person requesting the adjustment, ensuring to include their professional designation if relevant.
12. Enter the phone number of the individual making the request for follow-up.
13. Complete the date section to signify when the form is being submitted.
14. Review all entries for accuracy and clarity before finalizing the document.
15. Save changes to the form, and choose to download, print, or share the form as required.

Complete your documents online today for efficient processing!