Get Oh Aetna Better Health Prior Authorization Form 2017-2025

Completing the OH Aetna Better Health Prior Authorization Form online is a straightforward process that ensures your requests for healthcare services are handled efficiently. This guide provides a step-by-step walkthrough of each section and field of the form to assist you in filling it out accurately.

Follow the steps to successfully complete the form.

1. Press the ‘Get Form’ button to access the form and open it in the appropriate editor.
2. In the 'Date of Request' field, enter the current date to document when the authorization is being requested.
3. Fill in the 'Member Information' section with the member’s name, ID number, date of birth, and physician name. Additionally, note if the member has other insurance coverage, indicating it in the provided space.
4. Indicate the member's gender by circling either 'F' for female or 'M' for male.
5. Complete the 'Requesting Physician or Provider Information' section by adding the referring provider's name, facility name, addresses, telephone numbers, fax numbers, specialty, and National Provider Identification (NPI) numbers for both the referring and requesting providers.
6. In the 'Referral / Authorization Information' section, provide the problem or diagnosis using the appropriate ICD-10 code(s) in the designated space.
7. Detail the procedure or test being requested by entering the necessary CPT code(s). Include the date of the appointment or service and the number of visits required.
8. Select whether the type of procedure is inpatient, outpatient, or in-office by circling the appropriate option.
9. Provide any additional clinical information required, including clinical notes or lab and X-ray reports. If more space is needed, you can attach additional pages.
10. Once all sections are complete and accurate, you can save changes, download the form, print it, or share it as needed.

Complete your Aetna Better Health prior authorization form online today for a seamless submission experience.