Aetna Medicare Provider Appeal Form. You may mail your request to: Coordination of benefits (cob) employee assistance program (eap) medicaid disputes and appeals.
Index of Network Provider
An appeal is a formal way of asking us to review and change a coverage decision we made. To obtain a review, you’ll need to submit this form. Web (this information may be found on correspondence from aetna.) you may use this form to appeal multiple dates of service for the same member. Make sure to include any information that will support your appeal. Coordination of benefits (cob) employee assistance program (eap) medicaid disputes and appeals. You must complete this form. Or use our national fax number: Make sure to include any information that will support your appeal. There are different steps to take based on the type of request you have. You may mail your request to:
File a complaint about the quality of care or other services you get from us or from a medicare provider. To obtain a review, you’ll need to submit this form. Appeals must be submitted by mail/fax, using the provider complaint and appeal form. Coordination of benefits (cob) employee assistance program (eap) medicaid disputes and appeals. Find a form find forms for claims, payment, billing, medicare, pharmacy and more. Make sure to include any information that will support your appeal. Make sure to include any information that will support your appeal. This form may be sent to us by mail or fax: File a complaint about the quality of care or other services you get from us or from a medicare provider. Aetna medicare appeals po box 14067 lexington, ky 40512. Web (this information may be found on correspondence from aetna.) you may use this form to appeal multiple dates of service for the same member.
