Aetna predetermination form 2025

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To ensure that the medical service ordered is medically necessary and the most appropriate treatment for your condition, prior approval may be required. This is known as precertification for services ordered by a Participating Provider or Non-Participating Provider.
Aetna will confirm the pre-determination of medical benefits in writing to you. Determination of eligibility and fees will be based solely on the information you provide. If the information on the actual claim differs in any way from the information you submit on this form, appropriate adjustments will be made.
Your health care provider can make the prior authorization request. If your provider submits the request, they will send the required information to your health plan. You may need to fill out forms for your providers office.
Medical records can be uploaded directly through Aetnas provider portal on Availity or sent to Aetna by fax to 1-833-596-0339.
Please call the appropriate number below and select the option for precertification: 1-888-MD-AETNA (1-888-632-3862) (TTY: 711) for calls related to indemnity and PPO-based benefits plans. 1-800-624-0756 (TTY: 711) for calls related to HMO-based benefits plans.
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