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Recertification Request (, Gran ix, Ninety, Mario)Aetna Recertification Notification Phone: 18667527021 FAX: 18882673277Page 1 of 2 (All fields must be completed and legible for recertification review.)

How to fill out aetna precertification notification formampquot

How to fill out aetna precertification notification formampquot

1. To fill out the Aetna precertification notification form, follow these steps:
2. Start by filling out the patient information section. Provide the patient's name, date of birth, and Aetna ID number.
3. In the next section, indicate the healthcare provider's information. Enter the provider's name, address, phone number, and Aetna provider ID.
4. Specify the service or procedure that requires precertification. Include the diagnosis code and the CPT code, if applicable.
5. Provide details about the healthcare facility where the service or procedure will take place. Include the name, address, phone number, and facility type (hospital, clinic, etc.).
6. Indicate any related treatments or services that have already been provided to the patient.
7. Attach any supporting documentation, such as medical records or test results.
8. Sign and date the form to certify the accuracy of the information provided.
9. Submit the completed form to Aetna via fax or mail, as instructed on the form.
10. Note: It is important to ensure that all required fields are completed accurately to avoid delays in precertification.

Who needs aetna precertification notification formampquot?

1. The Aetna precertification notification form is required for anyone who is planning to receive a healthcare service or procedure that requires precertification. This includes Aetna members and healthcare providers who participate in the Aetna network.
2. Precertification is typically required for services that are considered elective, non-emergency, or expensive. It helps ensure that the requested service is medically necessary and covered by the member's insurance plan.
3. It is recommended to check with Aetna or the healthcare provider to determine if precertification is necessary for a specific service or procedure.

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What is aetna precertification notification form?

The Aetna precertification notification form is a document that healthcare providers use to obtain prior authorization from Aetna for certain services, procedures, or medications before they are performed or prescribed.

Who is required to file aetna precertification notification form?

Typically, healthcare providers and facilities submitting requests for prior authorization on behalf of their patients are required to file the Aetna precertification notification form.

How to fill out aetna precertification notification form?

To fill out the Aetna precertification notification form, healthcare providers should provide patient details, the specific service or procedure requested, relevant medical history, and any supporting documentation as required.

What is the purpose of aetna precertification notification form?

The purpose of the Aetna precertification notification form is to ensure that the requested services are medically necessary and to facilitate the approval process for healthcare services before they are rendered.

What information must be reported on aetna precertification notification form?

The information that must be reported includes patient identification, the type of service or procedure requested, diagnosis codes, provider details, and any relevant clinical information to support the request.