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  • Request For Exclusion From Paper Shut Off Aetna Form

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Request for Exclusion from Paper Shut-off This form is intended for use by providers who have received a letter from Aetna regarding shut-off of their paper explanation of benefits EOB and wish to continue receiving paper EOBs. TIN Name Tax ID Number TIN Contact Name Email Address Telephone Number Primary Service Address Fax Number Pay to/Billing National Provider Identifier NPI Information Regarding Request for Exclusion Have you received a letter from Aetna stating that your paper explanation of benefits will be discontinued Yes No What is your reason for not turning off paper EOBs Difficulty navigating secure website via NaviNet Concerns with account reconciliation Other please explain U Please Note If you are currently receiving ERAs you are not eligible to receive paper EOBs. Would you reconsider receiving EOBs electronically in the future Yes in the next 30 days Yes in 30 to 60 days Yes in 90 days By signing below I understand that I am instructing Aetna to send paper copies of e....

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232