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Medication Precertification Request Aetna Precertification Notification Phone 1-855-240-0535 FAX 1-877-269-9916 Page 1 of 2 All fields must be completed and legible for Precertification Review. Primary ICD Code Secondary ICD Code Other ICD Code G. CLINICAL INFORMATION Required clinical information must be completed in its entirety for all precertification requests. PRESCRIBER INFORMATION NPI Primary Care D. O. N.P. P. A. DEA UPIN Office Contact Name Neurologist M. For All Requests Relapsing-...

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