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How to use or fill out Precertification Request Form for Non-Participating Providers - Aetna with Our Platform
- Click ‘Get Form’ to open the Precertification Request Form in our editor.
- Begin by filling out Section A, 'Requesting Provider Information.' Enter the provider's name, ID number, contact name, telephone and fax numbers, and the request date.
- Proceed to Section B, 'Patient Information.' Input the patient's name, date of birth, Aetna ID number, address, and telephone number.
- In Section C, 'Nonparticipating Provider Information,' provide details about the nonparticipating provider including their name, contact information, specialty or ID number, and whether the patient has seen this provider before.
- Move to Section D for 'Reason for Nonparticipating Provider Request.' Clearly outline the services needed, diagnosis codes, procedure codes, and explain why these services can only be provided by this specialist.
- Finally, complete Section E by signing and dating the form. Ensure all fields are filled accurately before submission.
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