Get Aetna Gc-12437 2016

This guide provides a clear and comprehensive overview of how to accurately complete the Aetna GC-12437 form online. By following these instructions, users of all experience levels can effectively manage their dental benefits requests.

Follow the steps to successfully complete the Aetna GC-12437 form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling in the employer's name and address, ensuring to include Aetna Dental and the necessary mailing information.
3. Provide your policy/group number, which is typically associated with your dental plan. Make sure this information is accurate.
4. Fill in your employee details, including your birthdate, Aetna ID number, and full name.
5. Complete your address and daytime telephone number, ensuring all details are clear and correct.
6. Input the patient’s details such as their name, birthdate, and Aetna ID number. If the patient is a full-time student, include their expected graduation date.
7. Indicate the patient’s gender and relationship to the employee, selecting from the provided options.
8. If applicable, specify if the claim relates to an accident and provide necessary details, including dates and times.
9. Disclose whether any family members receive coverage under another health plan by answering the relevant questions.
10. Review the authorization section for releasing patient information. Ensure it is signed and dated.
11. Complete dentist information, including their name, address, and taxpayer identifying number if applicable.
12. Indicate the type of treatment requested, checking the appropriate box for pre-treatment estimate or statement of services rendered.
13. Fill in the procedure and fee details, ensuring each service is accurately noted.
14. Once you have filled out all necessary sections, review the form thoroughly for accuracy and completeness.
15. Save changes, download, print, or share the form as needed to complete the submission process.

Complete your Aetna GC-12437 form online today to ensure timely processing of your dental benefits.