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Get Aetna Referral Form Pdf

Phone: 18552323596 Fax: 18447977601 Date of Request: For urgent requests (required within 24 hours), call Aetna Better Health of New Jersey at 18552323596 MEMBER INFORMATION Name: ID Number Date of.

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Related links form

SSA HA-4631 1996 SSA RM 00202.055 SSA-16-F6 1999 SSA-3105 2013

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Contact support

What is retrospective review? Retrospective review is the process of determining coverage after treatment has been given. These evaluations occur by: Confirming member eligibility and the availability of benefits.

You may submit retrospective review requests for services requiring authorization on members that are retro actively eligible to 1-844-227-9205.

To initiate a request, submit electronically on Availity or call our Precertification Department. Submit your medical records to support the request with your electronic submission. We've made it easy for you to authorize services and submit any requested clinical information.

If you're part of an independent practice association (IPA), follow current referral procedures for members HMO plans. Referrals for Managed Choice® plan and Elect Choice® plan members are valid for one year from the original issue date.

Some procedures (For instance, an MRI, CAT scan or surgery.) need approval in advance. Your doctor can ask for this approval up to six months ahead of time.

Retrospective Review means that the services provided to you are reviewed after they have taken place.

We'll also communicate with your provider throughout the process. We'll come to a decision within 14 days and notify you and your doctor.

With an HMO plan, you must stay within your network of providers to receive coverage. Under a PPO plan, patients still have a network of providers, but they aren't restricted to seeing just those physicians. You have the freedom to visit any healthcare provider you wish.

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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