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  • New Jersey Application/change Request Aetna Life Insurance ...

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Er Requested Effective Date / / 2. Change - Check all that apply. Date of Event Reason Add Spouse/Civil Union Partner* / / Add Domestic Partner* / / Add Dependent Child* / / Name Change / / Change Plan / / Other / / Add/Change Office ID Numbers and/or NPI Numbers: Primary/OB/Gyn 3. Remove or Terminate - Check all that apply. Effective Date Reason Remove Applicant* / / Remove Spouse/Civil Union Partner* / / Remove Domestic Partner* / / Remove Dependent Child* /.

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Aetna Medicare PO Box 981106 El Paso, TX 79998-1106 This card does not guarantee coverage. Payer ID# 60054 Medicare limiting charges apply.

Use our electronic payer ID #60054. Aetna Medicare is a PDP, HMO, PPO plan with a Medicare contract.

Filing a claim is really that simple. 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.

El Paso, TX 79998-1106 Submit all paper claims for covered services as soon as possible using an Aetna claims form or by using the standard CMS-1500 or UB-04 form.

Have questions or need language help? Just call 1-855-232-3596 (TTY: 711). We're here for you 24 hours a day, 7 days a week.

El Paso, TX 79998-1106 Submit all paper claims for covered services as soon as possible using an Aetna claims form or by using the standard CMS-1500 or UB-04 form.

All medical bills including audio services for ASEA Health Trust participants must be submitted directly to Aetna at PO Box 981106, El Paso, TX 79998-1106. Click here for information about how to submit electronic claims.

Aetna Better Health of New Jersey part of Aetna, one of the nation's leading health care providers and a part of the CVS Health® family. We have over 30 years of experience serving Medicaid populations including children, adults and people with disabilities or other serious health conditions.

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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
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
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 WorkFlow
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