Sign the claim form below. Title: Aetna Claim for Hospital and Other Medical Expenses Author: WB408057 Created Date: 5/22/2018 11:20:44 AM Available for PC, iOS and Android. • Send this completed claim form and documentation to: Aetna P.O. Claims submission made easy . ... or (5) claim-based measures. HCFA-1500 SM. Please tape small receipts on a full size sheet of paper. Plus, with Aetna Vision. The most secure digital platform to get legally binding, electronically signed documents in just a few seconds. Box 981543 El Paso, TX 79998-1543 USA Telephone: +1-877-677-7470 (Toll Free, outside the USA, via AT&T + access) 3. Please mail or fax completed Claim Form with itemized bills and receipts. The benefits are clear. 4. The. Start a … Be sure to indicate member name, address, dependent name if applicable, describe sickness or accident, physician’s name and address, if not provided on the bill, sign and date the form. A specific facility provider of service may also utilize this type of form. You can also send us a secure email by logging in to . Preferred Network providers across the nation, you have access to If you're filing a claim for more than one person, a When you stay in-network, you save more money and get the full value of your vision benefits. This form can be used to submit a claim for medical, dental, vision, or pharmaceutical services. Box 8504 Mason, OH 45040-7111 Please allow at least 14 calendar days to process your claims once received by Aetna Vision. Choose between reading them online or printing. Mail this completed form and your original receipts and itemized bills to the medical claims address on your Aetna Medicare member ID card. the back of your Aetna ID Card. Medical Claim Form (PDF) Dental Claim Form (PDF) Vision Claim Form (for vision included in medical plans) (PDF) Vision Claim Form (for FEDVIP Aetna Vision℠ Preferred Plan) (PDF) Aetna Direct plan Medicare Part B Premium Reimbursement Request Form (PDF) HealthFund Reimbursement Form (PDF) Deemed Exhaustion and Immediate Claims Appeal. Things to remember 1. Fill out, securely sign, print or email your aetna claim form online instantly with SignNow. Box 3000 Richmond, KY 40476-3000 Fax to: 1-888-AET-FLEX [Important Notes] If you are submitting a claim with a change in your mailing address, you must notify your employer to make the change on your HRA enrollment file to avoid misdirected claim payments. Before we get started: Basic Concepts. Stay in-network and save on your next visit* Choose an in-network provider . www.aetnainternational.com and clicking 'Contact us'. UB-04 (CMS 1450) is a claim form used by hospitals, nursing facilities, in -patient, and other facility providers. The … Aetna Medical Claim Forms. The. Return the completed form and your itemized paid receipts to: Aetna Vision Attn: OON Claims P.O. Aetna offers health insurance, as well as dental, vision and other plans, to meet the needs of individuals and families, employers, health care providers and insurance agents/brokers. New users can register to access and existing members can log in to Aetna's secure member website to manage their health benefits. ©2018 Aetna Inc. 3 Proprietary. Complete an online claim form (Click here to download form). Or you can fax this completed form, your original receipts and itemized bills to 1-866-474-4040. Track your claims, view your member ID card, refill prescriptions or find a nearby doctor or hospital. Your claim will be processed in the order it … Aetna Global Benefits/Aetna P.O. For complete terms and conditions, review the claim form. Get Aetna Medicare forms and documents for enrollment, claims, appeals and grievances, and prescription drug delivery. 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