Get Aetna Medicare Viscosupplementation Form

Filling out the Aetna Medicare Viscosupplementation Form online can seem daunting, but with clear guidance, you can navigate the process seamlessly. This guide will provide step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin with section A, which focuses on patient information. Fill in all required fields, including the first name, last name, address, and contact information. Ensure all details are legible.
3. Proceed to section B for insurance information. Here, you will enter the Aetna member ID and group number. Indicate if there is any other coverage and provide the necessary details.
4. Move to section C to input prescriber information. Complete all fields about the prescriber, including their NPI number and contact information. This section ensures the prescriber is recognized in the approval process.
5. In section D, provide dispensing provider or administration information. Select the place of administration and fill in the provider's contact details.
6. Section E requires you to specify the product information. Indicate the requested viscosupplementation injectable medication, including dosage and HCPCS code.
7. Complete section F by indicating the primary ICD code and any additional ICD codes relevant to the condition being treated.
8. Section G involves providing clinical information. Carefully answer the questions regarding prior treatments, diagnosis, and symptoms to ensure they reflect accurate medical history.
9. Before finalizing the form, review all the sections for completeness to avoid any delays in precertification. Ensure all answers are clear and legible.
10. Once satisfied with the information provided, you can save your changes, download the form for your records, or print it for submission. Lastly, ensure to send it via the appropriate method to avoid any missed submissions.

Complete your Aetna Medicare Viscosupplementation Form online today for a streamlined approval process.