Precertification Guide for Aetna Health Plans

This document is a guide for healthcare providers regarding the precertification process for patients enrolled in Aetna health plans, effective April 1, 2024. It outlines the procedures for obtaining prior authorization, also known as precertification, for various services, programs, and prescriptions. The guide includes information on how to submit precertification requests, emphasizing the importance of completing all required sections and submitting requests at least two weeks in advance. It details the types of services that require precertification, including inpatient confinements, certain elective procedures, and specific drugs. Additionally, the document provides contact information for inquiries related to the precertification process and highlights that the information is applicable to various Aetna plans while noting exceptions for certain plans. The guide serves as a reference for Current Procedural Terminology (CPT) codes and best practices for working with Aetna.