Get Aetna Referral Form

The Aetna Referral Form is a crucial document for obtaining necessary authorizations for medical services. Filling out this form accurately ensures that requests are processed efficiently and effectively, enabling timely patient care.

Follow the steps to complete the Aetna Referral Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin filling in the member information section. Enter the member's full name, ID number, date of birth, and physician's name. Ensure the information is accurate to avoid any delays.
3. In the other insurance section, disclose any additional insurance coverages, if applicable. This can help with coordinating benefits.
4. For gender, select the appropriate option by circling either 'F' for female or 'M' for male. This information may be relevant for certain procedures.
5. Fill out the requesting physician or provider's information, including the referring provider's name, place of service, address, telephone, fax number, specialty, and National Provider Identification (NPI).
6. Next, provide the referral/authorization information. Enter the problem or diagnosis using appropriate ICD-9 codes, and outline the procedure or test requested with CPT codes.
7. Specify the date of the appointment or service and the number of visits required. This information helps facilitate scheduling and resource allocation.
8. Circle the type of procedure, selecting whether it is inpatient, outpatient, in-office, or other, based on the nature of the service being requested.
9. Lastly, include any additional clinical information, such as clinical notes, lab, and X-ray reports. Attach further pages if necessary to ensure comprehensive information is provided.
10. After completing the form, review all entries for accuracy. Save changes, then choose to download, print, or share the form as needed.

Complete your Aetna Referral Form online for efficient processing of your healthcare requests.