Get Aetna Gc-1652 (formerly Gc-1360) 2018-2026

This guide provides step-by-step instructions to assist users in filling out the Aetna GC-1652 (Formerly GC-1360) form online. By following these instructions, you can ensure that your form is completed accurately and efficiently.

Follow the steps to successfully complete the Aetna GC-1652 form online.

1. Press the ‘Get Form’ button to access the Aetna GC-1652 form in your preferred online editing tool.
2. Enter your Aetna member number in the designated field, as the claim cannot be processed without it.
3. Provide your group number, especially if applicable.
4. If you are enrolled in Medicare, indicate this by checking the appropriate box.
5. Fill in the employee's birthdate using the MM/DD/YYYY format.
6. Enter the employee's full name, including first, middle, and last names.
7. Complete the employee's address, including street, city, state, and ZIP code.
8. Specify the company name and address where the employee is employed.
9. Sign and date the form where indicated, ensuring the signature is from the employee.
10. Provide a telephone number where you can be reached.
11. Complete the patient’s details, including last name, first name, middle initial, gender, and birthdate.
12. Indicate if any family members' expenses are covered by another health plan or insurance, answering 'Yes' or 'No' as appropriate.
13. If 'Yes,' list the policy or contract holder's information, including policy numbers and the insurance company's name and address.
14. Check the applicable Medicare parts if filing is based on a Medicare claim.
15. Indicate the reason for filing the claim manually, choosing from options like Coordination of Benefits, Emergency, or Compound Drug.
16. Attach detailed prescription receipts as required, ensuring all information is clear and complete.
17. Confirm that all necessary documents are attached, then save your changes.
18. Options will be available to download, print, or share your completed form.

Complete your Aetna GC-1652 form online now for a seamless claims process.