Get Aetna Gr-68995-2 2015
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How to fill out the Aetna GR-68995-2 online
This guide provides clear, step-by-step instructions to assist you in completing the Aetna GR-68995-2 Gender Reassignment Surgery Precertification Information Request Form online. By following these guidelines, you can ensure that you include all necessary information for your precertification request.
Follow the steps to accurately complete your form.
- Use the ‘Get Form’ button to obtain the form and open it in the designated editor.
- Provide general information in Section 1, including the member's name, administrative reference number, member ID, date of birth, and the requesting provider or facility's details.
- In Section 2, indicate whether this is a new or continued treatment. Answer questions regarding the patient’s gender dysphoria, capacity to consent, and any significant medical or mental health concerns.
- If applicable, select the service type in Section 3 for female-to-male services. Provide details regarding hormone therapy and referral letters from mental health professionals.
- If the request is for male-to-female services, complete Section 4 by selecting the requested services and answering the relevant therapy questions.
- In Section 5, ensure to attach all necessary documentation, such as the current history and physical, office notes, and treatment descriptions along with mental health referral letters and hormone therapy documentation.
- Review your completed form before signing in Section 7. Remember, this form cannot initiate a precertification request; for that, you must call the Precertification Department or submit a request electronically.
- Once you have filled out the form, submit it along with all requested medical documentation to the Precertification Department via fax or mail. Make sure to contribute to a complete and accurate submission.
Complete your forms online today and ensure a smooth precertification process.
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Aetna provides an online portal that members can access for managing their plans, including the Aetna GR-68995-2. Through this portal, you can submit claims, check claim status, and request prior authorizations. It’s a user-friendly platform designed to enhance your experience. For navigating the portal and maximizing its features, uslegalforms can offer tutorials and tips.