Get Aetna Gr-68995-2 2020

Filling out the Aetna GR-68995-2 form is essential for providing the necessary information for precertification requests related to gender-affirming surgeries. This guide will help you understand each section of the form and ensure you complete it accurately.

Follow the steps to complete the Aetna GR-68995-2 form effectively.

1. Press the ‘Get Form’ button to access the form and open it in your editor.
2. In Section 1, provide general information about the member. Fill out their name, reference number, member ID, and date of birth. Include the requesting provider's name, NPI, phone number, and fax number.
3. Proceed to Section 2 and complete the patient-specific information. Indicate whether this is a new or continued treatment, and answer the questions regarding the patient's gender dysphoria, decision-making capacity, medical concerns, and mental health status.
4. If requesting female-to-male/non-binary services, fill out Section 3. Select the requested services and provide the necessary referrals from mental health professionals, hormone therapy details, and confirm living in a gender role consistent with their identity.
5. If requesting male-to-female/non-binary services, navigate to Section 4 and select the requested services, ensuring you provide similar details about referrals, hormone therapy, and living in a gender role congruent with their identity.
6. In Section 5, gather and upload all required documentation, including a current history and physical, office notes, proposed treatment descriptions, and any relevant mental health documentation.
7. Carefully review Section 6 for important information regarding fraudulent activity related to the form.
8. Finally, sign the form in Section 7, providing your name, signature date, and the contact name and telephone number of the office personnel for any questions.
9. Once completed, submit the form and all documentation electronically or via fax or mail to the appropriate department.

Complete your forms online today to ensure timely processing of your requests.