Aetna precertification form 2026

1. Click ‘Get Form’ to open the Aetna Precertification Form in our editor.
2. Begin by filling out the patient information section. Enter the patient's first name, last name, date of birth, and contact details. Ensure all fields are legible.
3. In the insurance information section, provide details about the patient's insurance coverage, including member ID and group number if applicable.
4. Complete the prescriber information section with the prescriber's name, contact details, and specialty. This is crucial for processing the precertification request.
5. Fill out the dispensing provider/administration information. Specify where the medication will be administered and provide relevant contact details.
6. In the product information section, indicate the requested medication (Aflibercept) along with dosage and directions for use.
7. Provide diagnosis information by entering primary and any additional ICD codes as required.
8. Complete clinical information by answering all questions regarding treatment history and patient responses to previous medications.
9. Finally, ensure that all sections are completed before signing and dating at the acknowledgment section to finalize your request.

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