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3.9 out of 5

28 votes

The document is a Prescription Drug Claim Form for Aetna Pharmacy Management, intended for Medicare members. It outlines the steps for members and pharmacists to complete the form accurately to ensure claims are processed. Key instructions include providing complete member information, obtaining pharmacist signatures, and mailing the form to the specified address. It also includes warnings about fraudulent claims and legal consequences for providing false information.

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Versions	Form popularity	Fillable & printable
2011	3.9 Satisfied (28 Votes)
2006	4.9 Satisfied (50 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How do I get a CMS 1500 form?

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).

How do I get a Medicare prescription claim form?

Form CMS-1696 can be downloaded at .cms.gov or obtained by calling the Customer Service number on your member ID card. The claim may be submitted via mail or fax to the address or phone number on the Medicare Part D Prescription Drug Claim Form.

Where do I get Medicare forms?

Centers for Medicare Medicaid Services (CMS). The link on the CMS website @ . cms.gov will help you search for the forms you need. Just print the forms, fill them out, and send them to the address listed on the forms.

How to submit a prescription claim with Aetna?

To submit a claim: Keep receipts for all prescriptions that you paid for out of pocket. Be sure to include your Aetna member ID number on each receipt. Print and complete the prescription drug claim form. Mail the receipts and claim form within two years of the date of purchase. You can find the address on the form.

How to get reimbursed for a prescription from Medicare?

Form CMS-1696 can be downloaded at .cms.gov or obtained by calling the Customer Service number on your card. The claim may be submitted via mail or fax to the address or phone number on the Medicare Part D Prescription Drug Claim Form. Reimbursement requests may be submitted up to 36 months from the date of service.

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What form do I need for Medicare reimbursement?

Generally, youll need to submit: The completed claim form (Patient Request for Medical Payment form (CMS-1490S) The itemized bill from your doctor, supplier, or other health care provider.

Does Aetna Medicare cover prescription drugs?

A Medicare Advantage prescription drug plan (or MAPD) is a plan that includes medical and prescription drug coverage. MAPD plans are only available through private insurers like Aetna.

Get the up-to-date aetna medicare prescription drug claim form 2025 now

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The best way to modify Aetna medicare prescription drug claim form in PDF format online

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How to submit a prescription claim with Aetna?

How to get reimbursed for a prescription from Medicare?

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