Get Aetna Referral Form Pdf

This guide provides a step-by-step process for effectively completing the Aetna Referral Form Pdf online. Whether you are a healthcare provider or a member, this resource is designed to assist you in accurately filling out the necessary information required for referrals.

Follow the steps to complete the form easily and efficiently.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the ‘Date of Request’ in the designated field. Ensure the date reflects the current date or the date you are submitting the form.
3. In the ‘Member Information’ section, fill in the member's name, ID number, date of birth, and telephone number. Provide the physician's name and any other insurance information if applicable.
4. Identify the member's gender by circling 'F' for female or 'M' for male. This information is often necessary for records.
5. Complete the ‘Requesting Physician or Provider Information’ section. Enter the referring provider's name, address, telephone number, and fax number. If applicable, also include the specialty, National Provider ID (NPI), Tax ID number (TIN), and the contact person's name.
6. In the ‘Referral/Authorization Information’ section, document the problem or diagnosis using the appropriate ICD-10 code(s) and provide details for any requested procedures or tests, including CPT code(s).
7. Specify the date of appointment or service and the number of visits required in their respective fields.
8. Select the type of procedure by circling the correct option, such as inpatient, outpatient, or skilled nursing. Provide any other clinical information that may be relevant.
9. Attach any supporting clinical information to the form, such as medical records or progress notes, to ensure that all necessary documentation is included.
10. Once all sections are completed, you can save changes, download, print, or share the form as needed.

Start filling out the Aetna Referral Form Pdf online today to ensure timely processing of your requests.