Forms

Below are forms that you may need as a member of Aetna Better Health of Ohio. These forms can help you manage claims, access information and more. If you need a form not listed here, contact us.

Notice of Privacy Practices (Eng/Spa)

Privacy Request Form

Appointment of Representative Form

Authorization to Release Protected Health Information (PHI)

Authorization to Release Psychotherapy Notes

Prior Authorization Form

Behavioral Health Prior Authorization Form

Transition of Care

Prescription Drug Mail Order Form (English & Español)

Coverage Determination Form

Coverage Redetermination Request Form

Medicare Part D Prescription Claim/Reimbursement Form (English & Español)

Hospice Part D Exception Form

Advance Directive Information

Member Advisory Committee Application