Have you ever had to use the Aetna cover sheet form? If so, you know that it can be a little confusing to fill out. In this post, we'll explain how to correctly complete the form so that your claim is processed as quickly as possible. Stay tuned for more tips on filing health insurance claims!
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. |