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  • Aetna Gc-1560-4 2018

Get Aetna Gc-1560-4 2018-2025

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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Electronic claims submission Use Payer ID# 128CA when submitting claims to Aetna Better Page 2 Health of California.

Electronic claims submission Use Payer ID# 128CA when submitting claims to Aetna Better Page 2 Health of California.

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

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?

Electronic claims Submit your dental claims and encounters electronically. Payer ID numbers are 60054 for Aetna claims and 68246 for Aetna encounters.

Home State's Payer ID is 68069.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232