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Get Aetna Gr-69265 2018
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How to fill out the Aetna GR-69265 online
Filling out the Aetna GR-69265 form is an important step in obtaining precertification for ® (aflibercept) injectable treatment. This guide provides a comprehensive walkthrough of the form, ensuring you provide all necessary information clearly and accurately.
Follow the steps to complete the Aetna GR-69265 form effectively.
- Click the ‘Get Form’ button to access the Aetna GR-69265 form and open it in your preferred online editor.
- Enter the start date of treatment in the 'start of treatment' section. Ensure that you input the date correctly in the format of month/day/year.
- Fill in the details for the 'Continuation of therapy' section by providing the date of the last treatment if applicable.
- Complete the 'Precertification Requested By' field with your full name and contact phone number.
- In the 'Patient Information' section, fill out the patient’s first name, last name, date of birth, state, and contact information, ensuring all fields are legible.
- Provide the patient’s height and current weight, and indicate if the patient has other insurance coverage by checking 'Yes' or 'No'. If applicable, enter their ID number.
- Fill in the 'Insurance Information' section with details such as the insurance carrier name, member ID number, and group number.
- Complete the 'Prescriber Information', listing the prescriber's full name, address, contact details, and relevant certifications or identifiers.
- In the 'Dispensing Provider/Administration Information', indicate the place of administration and fill out the relevant provider details.
- Fill in the 'Product Information' section by specifying the required dose of aflibercept and directions for use.
- Complete the 'Diagnosis Information' section with the primary ICD code and any other codes as necessary.
- Provide necessary clinical information in section G, answering all questions honestly and completely.
- Finally, review all entered information for accuracy. Once completed, you can save changes, download, print, or share the form again as needed.
Start filling out the Aetna GR-69265 form online to ensure your precertification request is submitted accurately and promptly.
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Yes, you can submit claims for Aetna GR-69265 online through the Aetna provider portal. Online submissions offer a convenient way to manage your claims efficiently. You can easily track the status of your claims and receive updates promptly. This method reduces paperwork and speeds up the reimbursement cycle.
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