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  • Aetna Dialysis Form

Get Aetna Dialysis Form

90935 Is the Dispensing Provider the same facility requesting Outpatient Dialysis Treatment? Yes Dialysis Facility: Phone: Fax: Precertification Requested By: Phone: If ASRx dispensing, ship to: A. PATIENT INFORMATION First Name: Aetna Precertification Notification 503 Sunport Lane Orlando, FL 32809 Phone: 1-866-503-0857 FAX: 1-888-267-3277 PIN: Phone: 90937 90999 Other No If no, provide facility information below: TIN: PIN: Fax: Last Name: Address: City: State: ZIP: Home Phone: Work Phon.

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We require providers to submit claims within 180 days from the date of service unless otherwise specified within the provider contract.

Medicare and Aetna Medicare won't be responsible either. ... For some services, your PCP is required to obtain prior authorization from Aetna Medicare. You'll need to get a referral from your PCP for covered, non emergency specialty or hospital care, except in an emergency and for certain direct access service.

We require providers to submit claims within 180 days from the date of service unless otherwise specified within the provider contract.

Urgent care claims You or your doctor may ask for an "expedited" appeal. Call the toll-free number on your Member ID card or the number on the claim denial letter. If your plan has one level of appeal, we'll tell you our decision no later than 72 hours after we get your request for review.

Click "Claims Center," then "Submit claims" Complete your claim online. Copy, scan and upload your supporting documents, including itemized bills, original receipts. Click "submit claim" to complete the process.

If additional information is needed, within 60 calendar days of receiving that information. Call: See phone numbers above. Write: Aetna Provider Resolution Team PO Box 14020 Lexington, KY 40512.

If an insurance company states that they never received your claim and the system indicates that it was acknowledged, then the payer may ask for Proof of Timely Filing. Note: Proof can only be provided for electronic claims.

Claims must be disputed within 180 days from the date of the initial decision.

*The timeframe is 180 calendar days for appeals involving utilization review issues or claims issues based on medical necessity or experimental/investigational coverage criteria.

First, you can request participation in the Aetna network by completing our online request for participation form. Next, we'll evaluate the current need to service our membership in your area.

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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