Get Aetna Gr-69375-2 2019-2026

Filling out the Aetna GR-69375-2 precertification information request form can be a straightforward process when approached step-by-step. This guide will provide you with clear instructions on how to accurately complete each section of the form online.

Follow the steps to complete the Aetna GR-69375-2 form effortlessly.

1. Press the ‘Get Form’ button to access the Aetna GR-69375-2 form online and open it for editing.
2. In Section 1, provide the general information required. Include the member's name, administrative reference number, member ID, date of birth, and contact details of the requesting provider or group.
3. Move on to Section 2 to outline the treatment plan. Specify the requested services, including any medications used, the start date of the cycle, and relevant details about donor sperm or eggs, if applicable.
4. Fill out Section 3, detailing the member's clinical history. Ensure to include the FSH level, E2 level, and the date those levels were collected.
5. In Section 4, submit only the necessary documentation for the request based on the treatment type. Follow the specified guidelines closely for each procedure.
6. Proceed to Section 5 to complete the advanced reproductive technology (ART) requests if applicable. Provide information related to previous cycles and any pertinent details regarding surgeries or other medical factors.
7. Review Section 6 information carefully. Understand that submitting false information can result in serious legal consequences.
8. Finally, sign the form in Section 7 and date your submission. Remember, submitting this form is not the initiation of a precertification request; that must be done electronically or via the Precertification department.
9. After completing the form, you can save your changes, download, print, or share the form as needed for further action.

Start filling out the Aetna GR-69375-2 form online today to ensure a smooth precertification process.