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Aetna authorized representative form 2025

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The document is an Authorized Representative Request form that allows a member to designate someone to act on their behalf in requesting services or filing complaints and appeals with Aetna. It includes provisions for the disclosure of Protected Health Information (PHI) to the authorized representative, outlines the implications of signing the form, and specifies that the authorization is valid only for the duration of the complaint or appeal.

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Versions	Form popularity	Fillable & printable
2015	4.7 Satisfied (54 Votes)
2013	4 Satisfied (31 Votes)

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is the number for 1 800 282 5366?

If youd like to get a total for the number of appeals, grievances and exceptions filed with Aetna Medicare, call us at 1-800-282-5366 (TTY: 711). Calls are answered 7 days a week, 8 AM to 8 PM.

What number is 1-800-624-0756?

National Medicare Dentist Line: Have a question? Call the National Medicare Dentist Line at 1-800-624-0756.

What is the phone number for Aetna insurance authorization?

If entered correctly, please call the appropriate number below and select the option for precertification: 1-888-MD AETNA (1-888-632-3862) (TTY: 711) for calls related to indemnity and PPO-based benefits plans. 1-800-624-0756 (TTY: 711) for calls related to HMO- based benefits plans.

What is CPB Aetna?

Medical Clinical Policy Bulletins (CPBs) detail the services and procedures we consider medically necessary, cosmetic, or experimental and unproven. They help us decide what we will and will not cover. CPBs are based on: Peer-reviewed, published medical journals.

What is the phone number for Aetna provider auth?

1-888-MD-AETNA (1-888-632-3862) (TTY: 711) for calls related to indemnity and preferred provider organization (PPO)-based benefits plans. 1-800-624-0756 (TTY: 711) for calls related to health maintenance organization (HMO)-based benefits plans.

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How to submit prior auth for Aetna?

Please submit your request electronically through Availity at .availity.com or call 888-632-3862 or 1-800-624-0756 to initiate precertification.

How do I get an authorization for Aetna?

To get prior authorization, your doctor must first submit a request for a specific procedure, test or prescription. They will look at your overall health or any chronic conditions to make that decision. Then theyll share the request with Aetna.

Aetna authorized representative form 2025

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What is the number for 1 800 282 5366?

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What is the phone number for Aetna insurance authorization?

What is CPB Aetna?

What is the phone number for Aetna provider auth?

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How to submit prior auth for Aetna?

How do I get an authorization for Aetna?

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