In a world where the accuracy and efficiency of information transmission are paramount, the Aetna Cover Sheet form serves as a vital tool for submitting documentation. Designed meticulously for Aetna members, this form streamlines the process of faxing documents by requiring specific details to be filled out, ensuring that the information reaches its intended destination without any hitches. With sections dedicated to the date of submission, attention to details such as the Aetna fax number, the total number of pages including the cover sheet, and sender information, every aspect of the form is crafted to facilitate a smooth submission process. Sender details like the name, telephone number, and fax number, alongside subscriber information including the Aetna Number, Member ID, and both the subscriber's last and first names, are meticulously gathered. Additionally, the form prompts for a brief reason for sending the information to Aetna, reinforcing the importance of context in communications. The note at the bottom underscores the confidentiality and the intended recipient's exclusivity of the transmitted information, highlighting the importance of privacy in handling sensitive documents. By setting clear guidelines and providing a template for information submission, the Aetna Cover Sheet form embodies a conscientious approach to document transmission, underlining the significance of orderly, secure, and efficient communication flows in the healthcare landscape.
| Question | Answer |
|---|---|
| Form Name | Aetna Cover Sheet Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | aetna fax cover sheet, gr 68559 1, aetna fax number, claim appeal coversheet payflex |
Cover sheet for
Aetna member FAX submission
Please complete this cover sheet and FAX with your documentation to be processed.
Date (MM/DD/YYYY)
Attention to
Aetna FAX number (include Area Code)
Total number of pages (including cover sheet)
Sender information
Sender name
Sender telephone number (include area code)*
Sender FAX number (include area code)
Subscriber information
Subscriber Aetna Number
Member ID (if different than the Subscriber ID)
Subscriber last name
Subscriber first name
Brief reason for sending information to Aetna
*"This information is intended only for the use of the individual or entity to which it is addressed, and may contain information which is privileged, confidential, or exempt from disclosure under applicable law. If the reader of this message is not the intended recipient, or the employer or agent responsible for delivering the message to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please notify the sender at the phone number above"
©2010 Aetna Inc. |