• Send this completed claim form and documentation to: Aetna P.O. Before we get started: Basic Concepts. Start a … Choose between reading them online or printing. 3. Plus, with Aetna Vision. Return the completed form and your itemized paid receipts to: Aetna Vision Attn: OON Claims P.O. The … Box 8504 Mason, OH 45040-7111 Please allow at least 14 calendar days to process your claims once received by Aetna Vision. The. UB-04 (CMS 1450) is a claim form used by hospitals, nursing facilities, in -patient, and other facility providers. Fill out, securely sign, print or email your aetna claim form online instantly with SignNow. Box 981543 El Paso, TX 79998-1543 USA Telephone: +1-877-677-7470 (Toll Free, outside the USA, via AT&T + access) SM. Preferred Network providers across the nation, you have access to Aetna Global Benefits/Aetna P.O. A specific facility provider of service may also utilize this type of form. For complete terms and conditions, review the claim form. ©2018 Aetna Inc. 3 Proprietary. Your claim will be processed in the order it … Complete an online claim form (Click here to download form). The most secure digital platform to get legally binding, electronically signed documents in just a few seconds. HCFA-1500 New users can register to access and existing members can log in to Aetna's secure member website to manage their health benefits. Title: Aetna Claim for Hospital and Other Medical Expenses Author: WB408057 Created Date: 5/22/2018 11:20:44 AM 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. Sign the claim form below. 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. Mail this completed form and your original receipts and itemized bills to the medical claims address on your Aetna Medicare member 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. Track your claims, view your member ID card, refill prescriptions or find a nearby doctor or hospital. You can also send us a secure email by logging in to . When you stay in-network, you save more money and get the full value of your vision benefits. If you're filing a claim for more than one person, a Get Aetna Medicare forms and documents for enrollment, claims, appeals and grievances, and prescription drug delivery. Please mail or fax completed Claim Form with itemized bills and receipts. Or you can fax this completed form, your original receipts and itemized bills to 1-866-474-4040. The two most common claim forms are the CMS -1500 and the UB -04. 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. ... or (5) claim-based measures. A separate Claim Form is needed for each family member. www.aetnainternational.com and clicking 'Contact us'. Claims submission made easy . Stay in-network and save on your next visit* Choose an in-network provider . Available for PC, iOS and Android. The. Please tape small receipts on a full size sheet of paper. the back of your Aetna ID Card. Aetna Medical Claim Forms. 4. This form can be used to submit a claim for medical, dental, vision, or pharmaceutical services. Things to remember 1. The benefits are clear. 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