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Provider materials and forms

Materials

Aetna Better Health® of Michigan (Medicaid) provider manual (PDF)

Aetna Better Health Premier Plan (Medicare-Medicaid plan) provider manual (PDF)

Forms

Waiver of liability (WOL) form (Medicare-Medicaid plan) (PDF)

Health risk assessment form (Medicaid) (PDF)

Compliance program guidelines provider attestation (Medicare) (PDF)

Physical health standard prior authorization request form (Medicaid) (PDF)

Physical health standard prior authorization request form - updated (Medicaid) (PDF)

Prior authorization form (PDF)

Coverage determination form (Medicare-Medicaid plan) (PDF)

Coverage determination online form (Medicare-Medicaid plan)

PAR provider dispute form (PDF)

Non-PAR provider appeal form (Medicaid) (PDF)

Non-PAR provider appeal form (Medicare-Medicaid plan) (PDF)

To learn more about pharmacy forms, you can visit our pharmacy PA page.

Helpful links and other info

Joint electronic funds transfer and electronic remittance advice signup

Provider notification - new prior authorization form (Medicaid) (PDF)

Getting started in ConnectCenter (PDF)

Getting started with eligibility in ConnectCenter (PDF)

Getting started with provider management in ConnectCenter (PDF)

Getting started with claims in ConnectCenter (PDF)

Uploading a claim in ConnectCenter (PDF)

Keying professional claims in ConnectCenter (PDF)

Keying institutional claims in ConnectCenter (PDF)

Obtaining a claim status in ConnectCenter (PDF)

Shared decision-making aids are communication tools used as a way for providers and patients to make informed health care decisions based on what is important to the patient. They do not replace physician guidance but are intended to help complement the discussions between patients and physicians on treatment decisions.

Here, you can learn about evidence-based aids that provide information about treatment options, lifestyle changes and outcomes.

Health topics (American Heart Association)
 

Diabetes (American Heart Association)

Flu prevention (American Heart Association)

Heart facts (American Heart Association)

Care that fits (Mayo Clinic)

Statin choice (Mayo Clinic)

Depression medication choice (Mayo Clinic)

Cardiovascular primary prevention choice (Mayo Clinic)

Member materials and forms

Find all the materials and forms a member might need — right in one place. 

Medicaid materials and forms

Medicare-Medicaid plan materials

Medicare-Medicaid plan forms