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How do I get prior auth for Aetna?
Fax this form to: 1-877-269-9916 OR Submit your request online at: https://www.availity.com Visit www.aetna.com/formulary to access our Pharmacy Clinical Policy Bulletins. This pre-authorization request form should be filled out by the provider.
How long does prior authorization take for medication Aetna?
You and your provider will get a letter stating whether the service has been approved or denied. We will make a decision within 5 business days, or 72 hours for urgent care.
How do I write a prior authorization request?
How to Write a Pre-authorization Letter for a Medical Procedure
- The demographic information of the patient (name, date of birth, insurance ID number and more)
- Provider information (both referring and servicing provider)
- Requested service/procedure along with specific CPT/HCPCS codes.
- Diagnosis (ICD code and description)
What is Aetna precertification?
Precertification occurs before inpatient admissions and select ambulatory procedures and services. Precertification applies to: Procedures and services on the Aetna Participating Provider Precertification List. Procedures and services on the Aetna Behavioral Health Precertification List.
Does Aetna Medicare PPO require prior authorization?
Generally, you must get your health care coverage from your primary care physician (PCP). Your PCP will issue referrals to participating specialists and facilities for certain services. For some services, your PCP is required to obtain prior authorization from Aetna Medicare.
How long does it take for Aetna to approve procedure?
How long will it take to process the application form? Processing your application form may take as long as three to four weeks. Please note that your coverage does not become effective until Aetna has underwritten and approved your application form.
Does Aetna Medicare PPO require referrals?
How do Medicare Advantage PPO plans work? Preferred provider organization (PPO) plans let you choose any provider who accepts Medicare. You don’t need a referral from a primary care physician for specialist or hospital visits. However, using providers in your plan’s network may cost less.
Does Aetna require preauthorization for surgery?
Aetna Better Health® of California requires prior authorization for select acute outpatient services and planned hospital admissions.
How long does it take Aetna to approve surgery?
Request authorization at least 15 days before the procedure, unless it’s an emergency. Use the electronic portal to submit the requests and medical records. You can request the service as soon as it is planned. We may be able to authorize up to six months for the patient to get the service done.