Po box 14079 lexington ky 40512 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering your name and Aetna ID number in the Employee Information section. Ensure that all details are accurate for smooth processing.
  3. Fill out the Patient Information section, including the Policy/Group Number and the patient's birthdate. If applicable, indicate if the address is new.
  4. In the Coverage Information section, answer whether any family members have expenses covered by another health plan. If yes, provide necessary details.
  5. Complete the Claim Information section by indicating if the claim is related to an accident or employment, and provide a description if applicable.
  6. Finally, sign and date the form in both the Release and Employee Certification sections to authorize information sharing and confirm accuracy.

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Within 180 calendar days of the initial claim decision. When will Aetna make a decision? Within 45 business days of receiving the request. (Timing depends on the request or if our specialty unit needs to review.)
Payer Name: Mental Health Network (MHNet)
The Rawlings Group serves health plan sponsors and self-funded plans throughout the nation with a comprehensive line of paid claims recovery services. These include: Subrogation and Workers Compensation recovery services. Medicare and commercial COB recovery services.
Our provider support teams are ready to help you find the info you need. Get help with benefits, claims, appeals, contracted rates and more. For Aetna Signature Administrators, Meritain Health, mental health services and substance abuse treatment: Call the number on your patients member ID card.
Aetna Senior Supplemental Insurance (Aetna SSI) Payer ID: 62118.

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