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