Get 18594558650

This guide provides comprehensive instructions on how to fill out the 18594558650 form online. By following the steps outlined below, you can ensure that you complete the form accurately and submit it with confidence.

Follow the steps to successfully fill out the form

1. Press the ‘Get Form’ button to access the online version of the form.
2. Begin with the employer information section. Enter the name of your employer and the policy or group number associated with your health plan.
3. In the employee information section, provide your full name, Aetna ID or Social Security number, and date of retirement. Indicate if you are active or retired.
4. For the patient information, enter the patient's address, Aetna ID or Social Security number, their relationship to you (self, spouse, or child), sex, birth date, and daytime telephone number. If the address has changed, select the option indicating a new address.
5. Complete the other coverage information section. Indicate whether the patient is employed and if expenses are covered by another health plan. If applicable, include the additional insurance policy details.
6. In the claim information section, confirm whether the claim is related to employment or an accident. If it is related to an accident, provide the date and time of the incident, along with a brief description.
7. Attach any required pharmacy receipts or prescription drug records when submitting the form. Ensure that these documents list the date, NDC number, drug name, and cost.
8. Review the release and employee certification section. By submitting the form, acknowledge consent for the use and release of health information as described.
9. Sign and date the form in the designated area, confirming that the information provided is true and complete.
10. Once all sections are completed, save any changes to the form. You can then download it, print, or share it as needed. Finally, send the completed form to Aetna Claim Office at the provided address or via fax.

Complete your documents online today for a smooth filing experience!