Aetna viscosupplementation form 2025

1. Click ‘Get Form’ to open the Aetna Viscosupplementation form in the editor.
2. Begin by filling out the 'Patient Information' section. Enter the patient's first name, last name, address, and contact details including home, work, and cell phone numbers. Don't forget to include their date of birth and any known allergies.
3. Next, move to the 'Insurance Information' section. Input the Aetna Member ID number and indicate if there is other coverage. If applicable, provide additional insurance details such as group number and carrier name.
4. In the 'Prescriber Information' section, enter the prescriber's details including their name, specialty, and contact information. Ensure that you check the appropriate box for their designation (M.D., D.O., N.P.).
5. Proceed to fill out the 'Clinical Information' section thoroughly. This includes answering questions about joint pain, previous treatments, and any contraindications for viscosupplementation.
6. Finally, review all sections for completeness before submitting your request. Ensure that all fields are legible and filled out correctly to avoid delays in precertification.

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