Aetna GR-67353-12 2014-2025 free printable template
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Precertification*/Preauthorization Nonparticipating Provider Request Aetna PO Box 14079 Lexington, KY 40512-4079 Fax: 859-455-8650 Instructions for the following type of plans: SM HMO, Aetna Health
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How to fill out Aetna GR-67353-12
01
Obtain the Aetna GR-67353-12 form from the Aetna website or your employer.
02
Review the instructions provided on the form.
03
Fill in your personal information including your name, address, and contact details.
04
Provide your policy number and other identification details as required.
05
Indicate the type of claim or request you are submitting.
06
Complete all relevant sections of the form, ensuring accuracy in your entries.
07
Attach any required documentation such as receipts or medical records.
08
Review your filled-out form for completeness and errors before submission.
09
Submit the form via the indicated method (mail, online, etc.) as directed.
Who needs Aetna GR-67353-12?
01
Individuals who are policyholders or beneficiaries under Aetna's insurance plans.
02
Those seeking to file a claim or request benefits through the Aetna GR-67353-12 form.
03
Employers who need to process health benefits for their employees under Aetna plans.
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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 specific group health insurance plan document that outlines the benefits, coverage, and terms offered by Aetna to its members.
Who is required to file Aetna GR-67353-12?
The employer or organization sponsoring the health insurance plan is required to file Aetna GR-67353-12 on behalf of the enrolled members.
How to fill out Aetna GR-67353-12?
To fill out Aetna GR-67353-12, the employer must provide accurate member information, coverage details, and any applicable deductions or contributions as specified in the document guidelines.
What is the purpose of Aetna GR-67353-12?
The purpose of Aetna GR-67353-12 is to establish a formal agreement between Aetna and the employer regarding the health insurance benefits provided to employees and their dependents.
What information must be reported on Aetna GR-67353-12?
The information that must be reported on Aetna GR-67353-12 includes employee names, dependent names, enrollment dates, coverage options selected, and any relevant payment details.
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