Aetna GR-67353-12 2013 free printable template

Recertification*/Preauthorization Nonparticipating Provider Request Aetna PO Box 14079 Lexington, KY 40512-4079 Fax: 859-455-8650 Instructions for the following type of plans: HMO, Aetna Health Network

How to fill out Aetna GR-67353-12

How to fill out Aetna GR-67353-12

1. Gather required personal information: Have your insurance details, claim numbers, and relevant personal identification ready.
2. Download the Aetna GR-67353-12 form from the Aetna website or request a physical copy.
3. Fill out the personal information section: Enter your name, address, phone number, and policy number accurately.
4. Provide details of the medical condition: Clearly describe the treatment or service received and the date it occurred.
5. Complete the claim details: Indicate the claim amount and attach any supporting documents such as receipts or bills.
6. Sign and date the form: Ensure that you sign the form to authorize the release of information.
7. Submit the completed form: Send the form to the address specified on the form, either via mail or electronically as directed.

Who needs Aetna GR-67353-12?

1. Individuals who are Aetna policyholders requiring reimbursement for medical services.
2. Patients who have undergone treatment covered under policy GR-67353-12.
3. Providers submitting claims on behalf of patients covered under this specific Aetna plan.

People Also Ask about

Is precertification the same as preauthorization?

Prior authorization—sometimes called precertification or prior approval—is a health plan cost-control process by which physicians and other health care providers must obtain advance approval from a health plan before a specific service is delivered to the patient to qualify for payment coverage.

Does Aetna Medicare require authorization?

You or your doctor needs approval from us before we cover the drug. For certain drugs, we limit the amount you can get. We require you to try another drug first before we cover your drug.

Does Aetna require pre authorization for MRI?

Some procedures (For instance, an MRI, CAT scan or surgery.) need approval in advance. Your doctor can ask for this approval up to six months ahead of time. You can share a copy of this guide with your doctor.

What is a medical exception for Aetna?

M EX = Medical Exception - This means the member or treating physician or health care professional must obtain a medical exception from Aetna, in order for the medication to be eligible for coverage. Medical Exception criteria apply to non-formulary drugs for members enrolled in or covered by closed benefits plans.

How long does it take for Aetna to approve an MRI?

Your health care provider will communicate with us directly, and generally within 14 days or less, you and your physician will be notified of a decision.

Does MRI need prior authorization?

An MRI is one of the expensive tests that may require prior authorization.

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What is Aetna GR-67353-12?

Aetna GR-67353-12 is a group insurance policy or form related to Aetna health insurance offerings.

Who is required to file Aetna GR-67353-12?

Employers or organizations that provide Aetna health insurance to their employees or members are typically required to file Aetna GR-67353-12.

How to fill out Aetna GR-67353-12?

To fill out Aetna GR-67353-12, you will need to complete the specified sections with relevant information about the group insurance plan, including details about members, coverage options, and employer information.

What is the purpose of Aetna GR-67353-12?

The purpose of Aetna GR-67353-12 is to document and facilitate the administration of group health insurance coverage provided by Aetna.

What information must be reported on Aetna GR-67353-12?

The information required to be reported on Aetna GR-67353-12 typically includes the policyholder's details, covered individuals, types of coverage, and any applicable premiums or benefits associated with the plan.