Aetna GC-14208 2010-2025 free printable template
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Prescription Drug Record Employer Information Employee Information Name Aetna ID Number Name Address (include zip code) Address is new Mail to: Aetna Life Insurance Company P.O. Box 14079 Lexington,
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How to fill out po box 14079 lexington ky form
How to fill out Aetna GC-14208
01
Obtain the Aetna GC-14208 form from the Aetna website or your healthcare provider.
02
Fill in your personal information at the top of the form, including your name, address, and Aetna member ID.
03
Provide details about the medical services received, including dates of service and provider information.
04
Indicate the reason for the claim and any relevant diagnosis codes if applicable.
05
Attach any supporting documentation, such as bills or receipts from the healthcare provider.
06
Sign and date the form to certify that the information provided is accurate.
07
Submit the completed form to the address specified on the Aetna GC-14208 form.
Who needs Aetna GC-14208?
01
Aetna GC-14208 is needed by members of Aetna who are filing a claim for reimbursement of medical services received.
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What is Aetna GC-14208?
Aetna GC-14208 is a form used by Aetna to collect information regarding specific insurance claims or policyholder details.
Who is required to file Aetna GC-14208?
Typically, insurance policyholders, healthcare providers, or entities submitting claims on behalf of a patient are required to file the Aetna GC-14208 form.
How to fill out Aetna GC-14208?
To fill out Aetna GC-14208, you should provide necessary personal and insurance information, description of services provided, and any relevant claim details as outlined in the form's instructions.
What is the purpose of Aetna GC-14208?
The purpose of Aetna GC-14208 is to ensure accurate processing of claims and to collect necessary data for underwriting and customer service related to health insurance policies.
What information must be reported on Aetna GC-14208?
The information that must be reported on Aetna GC-14208 includes policyholder details, claim information, service provider information, dates of service, and any relevant diagnosis or treatment codes.
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