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Get Aetna Ub4 Claim Form 2011

Ibed in the accompanying Notice, you must complete this Claim Form and then mail it to the proper address as indicated in Section I below. If you wish to confirm that your Claim Form has been received by Aetna, send it by certified mail, return receipt requested. All information provided to Aetna shall be treated confidential under applicable law and contract. Section A - Provider Identification Indicate below the Provider s name and mailing address: Provider s Name (If you are filing your.

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