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Click ‘Get Form’ to open the Aetna CMS 1500 form in the editor.
Begin by entering your Aetna Member Number at the top of the form, as this is essential for processing your claim.
Fill in your personal details including Employee Name, Address, and Birthdate. Ensure all information is accurate to avoid delays.
Indicate if you are enrolled in Medicare by checking the appropriate box and provide any relevant policy information if applicable.
For each prescription, complete the fields under 'Pharmacy Information' including Date Filed, Rx Number, Quantity, and Medication Details. Attach detailed receipts as required.
Once all sections are filled out, review your entries for completeness and accuracy before signing the form.
Submit the completed form via mail or fax to Aetna Pharmacy Management using the provided contact details.
Start filling out your Aetna CMS 1500 form online for free today!
Our internal coverage criteria are based on current evidence in widely used treatment guidelines or clinical literature and comply with CMS requirements.
Who fills out a CMS-1500 form?
The Health Insurance Claim Form (CMS-1500) is used by Allied Health professionals, physicians, laboratories and pharmacies to bill supplies and services to the Medi-Cal program. Providers are required to purchase CMS-1500 claim forms from a vendor.
Is a CMS-1500 form the same as a medical bill?
The CMS-1500 is used for billing professional services by non-institutional providers, while the UB-04 (CMS-1450) is used by institutional providers, like hospitals, to bill for inpatient and outpatient services.
Where can I get CMS-1500 forms?
In order to purchase claim forms, you should contact the U.S. Government Printing Office at 1-866-512-1800, local printing companies in your area, and/or office supply stores. Each of the vendors above sells the CMS-1500 claim form in its various configurations (single part, multi-part, continuous feed, laser, etc).
Where do I get a CMS 1500 form?
Amazon.com : NEW CMS 1500 Claim Forms - 500 Sheets (02/12 Version) for Laser or Inkjet Printers : Business Claim Forms : Office Products.
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The 1500 form, also known as the CMS-1500 form, is a standard form used by healthcare providers and medical billing companies in the United States to submit claims for processing with insurance companies (see Graphic 1).
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Feb 18, 2016 Aetnas shareholders approved the issuance of Aetna common stock in the Merger. Form of CMS Private Fee for Service Agreement (incorporated
If prescription drugs are covered under your plan, submit receipts or a Prescription Drug Record form. Receipt must contain: - drug name. - nature of illness
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