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Get Aetna GC-1560-4 2018-2024
Ffice Key Code 039 Complete this form when your disability absence goes beyond your plans waiting period. Ask your physician to complete the Attending Physician's Statement on the reverse side. 1. Employer Information Name Control Number 2342342344 Address (include ZIP Code) 2. Employee Information Social Security Number Name Birthdate (MM/DD/YYYY) ( Basic Income Has your employment terminated and/or are you currently on layoff? Daytime Telephone Number Address (include ZIP Cod.
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Ngn FAQ
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Home State's Payer ID is 68069.
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Electronic claims Submit your dental claims and encounters electronically. Payer ID numbers are 60054 for Aetna claims and 68246 for Aetna encounters.
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You can also print and mail claims forms to Aetna Voluntary Plans, PO Box 14079, Lexington, KY 40512-4079, or Fax to 1-859-455-8650. Claims forms are available for download from the bottom of the screen when you access the member portal or call Member Services. Have questions?
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Active Payer List - Effective February 2021 46320 AETNA BETTER HEALTH NEW JERSEY Non-Participating Payor 62118 Aetna Senior Supplemental Insurance (Aetna SSI) Participating Payor 38692 Aetna TX Medicaid & CHIP Participating Payor 13334 Affinity Health Plan Non-Participating Payor 64158 Agency Services Participating Payor45 more rows
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Electronic claims submission Use Payer ID# 128CA when submitting claims to Aetna Better Page 2 Health of California.
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Electronic claims submission Use Payer ID# 128CA when submitting claims to Aetna Better Page 2 Health of California.
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