Get Aetna Gr-68722 2020

Filling out the Aetna GR-68722 online is an essential step for initiating or continuing treatment with . This guide provides clear and detailed instructions to help users complete the form accurately and efficiently.

Follow the steps to complete the Aetna GR-68722 online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the start date of treatment and the date of the last treatment in the provided fields. Ensure all dates are formatted correctly.
3. Complete the Patient Information section, entering the patient's first name, last name, address, city, state, zip code, and contact numbers, as well as their date of birth and allergies. Be accurate and thorough in this section.
4. In the Insurance Information section, specify whether the patient has other coverage and if yes, provide their ID number. Fill out the Aetna Member ID and Group number fields accurately.
5. Complete the Prescriber Information section, entering the prescriber's first name, last name, address, phone, fax, specialty, and licensing details.
6. Fill in the Dispensing Provider/Administration Information section. Indicate the place of administration and provide the associated contact details. Specify if the patient is self-administering or receiving treatment at a healthcare facility.
7. In the Product Information section, request () by filling out the dose and frequency fields.
8. Provide the diagnosis information by entering the primary and secondary ICD codes as required.
9. Complete the Clinical Information section by indicating any required clinical details. Answer the yes/no questions fully with supporting information where necessary.
10. Lastly, sign and date the form in the Acknowledgement section to confirm that all information is complete and accurate.
11. After completing the form, users can save their changes, download, print, or share it as needed to submit the precertification request.

Complete and submit your documents online to ensure a smooth precertification process.