Aetna Medicare Provider Appeal Form

Aetna Medicare Complaint Team Fill Out and Sign Printable PDF

Aetna Medicare Provider Appeal Form. You have 60 calendar days from the date of your denial to ask us for an appeal. To obtain a review, you’ll need to submit this form.

You must complete this form. You may also ask us for an appeal through our website at www.aetnamedicare.com. You have 60 calendar days from the date of your denial to ask us for an appeal. Claim id number (s) reference number/authorization number. Make sure to include any information that will support your appeal. You must complete this form. This form may be sent to us by mail or fax: Aetna medicare appeals po box 14067 lexington, ky 40512. Web find forms and applications for health care professionals and patients, all in one place. Requesting an appeal (redetermination) if you disagree with medicare’s coverage or payment decision.

Web file an appeal if your request is denied. Get a medicare advantage provider complaint and appeal form (pdf) get a non medicare advantage provider complaint and appeal form (pdf) to facilitate handling: You may also ask us for an appeal through our website at www.aetnamedicare.com. 711) hospital discharge appeal notices (cms website) log in use our secure provider website to access electronic transactions and valuable resources to support your organization. There are different steps to take based on the type of request you have. Make sure to include any information that will support your appeal. File a complaint about the quality of care or other services you get from us or from a medicare provider. This form may be sent to us by mail or fax: Claim id number (s) reference number/authorization number. You have 60 calendar days from the date of your denial to ask us for an appeal. To obtain a review, you’ll need to submit this form.