Get Aetna Referral Form

This guide provides step-by-step instructions on how to accurately complete the Aetna Referral Form online. By following these detailed instructions, users can ensure they provide all necessary information accurately and efficiently.

Follow the steps to fill out the Aetna Referral Form online

1. Press the ‘Get Form’ button to access the Aetna Referral Form and open it for editing.
2. Fill in the member information section. This includes the member's name, ID number, date of birth, physician's name, and information about other insurance coverage.
3. In the requesting physician or provider information section, provide the name, address, telephone number, fax number, specialty, and National Provider Identification (NPI) for both the referring and requesting providers.
4. Detail the referral or authorization information. Include the problem or diagnosis using appropriate ICD-9 codes, and specify the requested procedures or tests with the corresponding CPT codes.
5. Indicate the date of the appointment or service, and specify the number of visits required. Select the type of procedure by circling inpatient, outpatient, in-office, or other.
6. Add any additional clinical information, such as clinical notes or lab and X-ray reports. If necessary, attach extra pages.
7. After completing the form, save your changes. You can then choose to download, print, or share the completed form as necessary.

Complete your Aetna Referral Form online today for a seamless experience.