Get Pre-authorization Request Form - Aetna Better Health

Filling out the Pre-Authorization Request Form for Aetna Better Health can be a straightforward process if you follow the right steps. This guide will provide you with clear and detailed instructions to help you complete the form accurately and efficiently.

Follow the steps to successfully complete the Pre-Authorization Request Form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by selecting the type of request. Choose from options such as urgent, non-urgent, inpatient, outpatient, home health care, DME, or RX/buy & bill. Your choice will determine the urgency and processing time of your request.
3. Complete the additional clinical patient information section. Fill in the patient's name (last, first, MI), identification number, date of birth, gender, and check if they have any other insurance, are job-related, or are currently pregnant.
4. In the section for the requesting provider, print the name of the requesting provider, tax ID number, contact person, clinical contact person, phone numbers, and the name of the primary care provider.
5. Enter the details of where the patient will receive services, including the physician/provider/facility requested, their address, and contact information. Additionally, specify the tentative date of service/admission.
6. Input the clinical information required, including ICD-10 codes and descriptions, as well as CPT/HCPCS codes and their descriptions.
7. Provide necessary comments to clarify the request, such as the number of days, visits, or units needed. Remember to mention that DME, therapies, and infusions must have prescriptions attached.
8. Finally, attach any clinical documentation or medical records that support your request. This may include evidence of conservative treatments tried and failed, applicable diagnostic testing results, lab values, and a medication list.
9. After reviewing all sections for accuracy, save your changes. You can then download, print, or share the form as needed.

Complete your Pre-Authorization Request Form online today to ensure timely processing of your request.