Aetna Cover Sheet Form PDF Details

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!

Form NameAetna Cover Sheet Form
Form Length1 pages
Fillable fields0
Avg. time to fill out15 sec
Other namesaetna fax cover sheet, gr 68559 1, aetna fax number, claim appeal coversheet payflex

Form Preview Example

Cover sheet for

Aetna member FAX submission

Please complete this cover sheet and FAX with your documentation to be processed.


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"

GR-68559-1 (12-10)

©2010 Aetna Inc.