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() Injectable Medication Precertification RequestAetna Precertification Notification Phone: 18667527021 FAX: 18882673277Page 1 of 2 (All fields must be completed and legible for Precertification.

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Aetna has contracted with eviCore healthcare, an independent specialty medical benefits management company, to administer prior authorization for Enhanced Clinical Review program.

Call the Aetna Pharmacy Precertification Unit: NonSpecialty 1-800-294-5979 (TTY: 711) or Specialty 1-866-814-5506 (TTY: 711).

Aetna partners with Novologix to offer free electronic prior authorization services for specialty drugs on Aetna's National Precertification List. You can use this service for commercial and Medicare members for all health plans.

Blue Cross Blue Shield of Michigan uses the NovoLogix® tool to manage prior authorization requests for medical benefit drugs. Note: Prior authorization requests for medical oncology and supportive care drugs are managed by Carelon Medical Benefits Management.

We will make a decision within 5 business days, or 72 hours for urgent care. If we deny your service, we will explain why in the letter.

The Current Procedural Terminology (CPT®) code 99499 as maintained by American Medical Association, is a medical procedural code under the range - Other Evaluation and Management Services.

inj, , Inj., Natpara, , , , and are currently listed on the Aetna Formulary Exclusions List. Therefore, these drugs are excluded from coverage for members enrolled in prescription drug benefits plans that use a closed formulary, unless a medical exception is granted.

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© Copyright 1997-2025
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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