Aetna Prior Authorization Form Guide 2026: Which Form, Fax, or Portal to Use

Does Aetna Have a Prior Authorization Form?

Yes. Some service-specific forms can open a review. Aetna's general Precertification Information Request Form (GR-68831, revised 11-25) has a different rule; its instruction page says: "Do not use this form to initiate a precertification request." Its first field asks for a reference number, and the form says that if you don't have one, you shouldn't use it.

The GR-68831 sequence, per that form:

1. Start the request on Availity with the Authorization (Precertification) Add transaction, or call the precertification line.
2. Answer the questionnaire if Availity shows one.
3. If the request pends, complete the form and attach it to the case on Availity. If you started by phone, attach it on Availity under your reference number or fax it to Aetna's FaxHub at 1-833-596-0339. FaxHub accepts clinical information only. Claims and other paperwork go to their usual fax numbers.
4. Mail is the last resort: PO Box 14079, Lexington, KY 40512-4079. The form warns that mailing slows the review.

Do not fax GR-68831 as a stand-alone new request. That rule does not apply to every Aetna form: the commercial Specialty Medication Medical Prior Authorization Request (04/26) expressly permits initiating review by faxing the completed form and supporting records to 1-888-267-3277. It directs Medicare Advantage requests to the Medicare fax forms. For another payer's plan-specific workflow, see the UHC prior authorization form guide.

Which Aetna Form, Portal, or Fax for Which Service

First confirm whether precertification is required for the exact member, service code and setting; then choose the route. The contacts below are conditional routes from Aetna's current list, not a rule that every member needs authorization or uses the same delegate.

Every number in the table comes from the 2026 precertification list, except the FaxHub number, which is printed on the Precertification Information Request Form and the Standard Organization Determination form. The commercial specialty drug fax and phone also appear on the Specialty Medication Medical Prior Authorization Request (revised 04/26). That form tells Medicare Advantage requests to use the Medicare fax forms instead.

Check the CPT code before you pick a route

Read the service-level exceptions, not just the vendor name. Aetna's November list, pages 6 and 37–46, specifies:

• Student Health and Allina Health | Aetna: no precertification for the listed outpatient diagnostic cardiology, hip/knee arthroplasty, home health, pain management, PVD, polysomnography, radiology imaging and radiation oncology services. This is not a general exemption for every service or setting.
• Setting matters: the radiology, polysomnography and radiation-oncology entries exclude inpatient, emergency-room and observation-bed settings from those outpatient programs. Cardiology, pain and PVD entries also identify emergency exceptions. Match the actual code and setting to its own entry.
• Federal plans: the Foreign Service Benefit Plan, MHBP and Rural Carrier Benefit Plan do not use EviCore for the named programs; follow the service entry and member-card contact. The PVD entry specifically says precertification is not required for those plans. The general federal-plan section separately distinguishes Original Medicare as primary from the corresponding Aetna Medicare Advantage options; do not assume a blanket federal-plan exemption.

Aetna's precertification code search checks up to five CPT codes at a time against the current list. It doesn't cover Medicaid. Aetna says it usually updates the list in January and July and may add newly FDA-approved drugs at other times, so a code that didn't need precertification last year may need it now.

Where Aetna Delegates Precertification by State in 2026

Some Medicare home health, post-acute, and oncology reviews go to a vendor based on the member's state. This is where routes most often go stale, because Aetna's list changes several of these on fixed dates.

All rows come from the special-programs section of the November 2026 precertification list, subject to the member, code and setting exceptions above. The list says precertification programs do not apply to fully insured Indiana members. Separately, Aetna's online Louisiana instruction asks Louisiana providers who are in the credentialing process to call the precertification number on the member's ID card rather than use EDI; it does not state that every Louisiana request must avoid EDI. Rhode Island has a separate code list.

Service-Specific Aetna Precertification Forms

Aetna publishes about 30 service-specific medical precertification forms on its health care professional forms page. They ask for the clinical details Aetna's policy for that service checks. Examples include:

• Orthopedic: hip arthroplasty, knee arthroplasty, shoulder arthroplasty, total ankle arthroplasty, hip surgery for impingement, spinal surgery
• Cardiac and neuro: cardiac catheter ablation, left atrial appendage closure, dorsal column stimulator, neurostimulator implantation
• Surgical and other: obesity surgery, breast reduction or reconstruction, panniculectomy and lipectomy, ptosis, sinus surgery, varicose veins, UPPP, gender affirming surgery
• Equipment and therapy: wheelchairs and scooters, lower limb prosthesis, hyperbaric oxygen, proton beam radiotherapy, skilled home private duty nursing
• Genetic testing: BRCA, whole exome sequencing

GR-68831 is the supplement-only form; do not extend that restriction to all service-specific forms. Check the applicable service form's own initiation and submission instructions. The commercial specialty-medication form, for example, starts review by completed fax with clinical records, while its Medicare Advantage note sends staff to the Medicare fax forms.

Medicare Advantage uses a different form

For Aetna Medicare Advantage, a request for a medical service is an organization determination. Aetna's Standard Organization Determination Information Request Form (GR-69463) is for Medicare Advantage plans only. The attending physician completes Sections 2 through 6. Aetna prefers electronic submission through Availity, and the form gives FaxHub 1-833-596-0339 for clinical information. To expedite, the form says to submit electronically (EDI) or call 1-800-624-0756.

For Medicare Advantage, Aetna applies CMS coverage policy first: national and local coverage determinations, then its Clinical Policy Bulletins when no NCD or LCD applies. Write the clinical narrative to the NCD or LCD criteria when one exists.

Aetna Prior Authorization Pre-Submission Checklist

Run through this checklist before you click submit. Each item comes from what Aetna's forms and 2026 list ask for, or from a rule they state. Aetna's list warns that missing records "may delay our review or cause a denial of coverage."

AETNA PRIOR AUTHORIZATION PRE-SUBMISSION CHECKLIST (2026)

Patient: ____________________   Aetna member ID: ______________
Plan type:  [ ] Commercial  [ ] Medicare Advantage  [ ] HMO  [ ] Medicaid (state rules)
Service date: ___________   Days until service: _____ (Aetna asks for 2+ weeks)

1. CONFIRM PRECERTIFICATION IS REQUIRED
[ ] CPT/HCPCS codes checked in Aetna's precertification code search
  (current list: updated November 1, 2026)
[ ] Plan is not Traditional Choice or indemnity (list does not apply)
[ ] Not a fully insured Indiana member (precert programs don't apply)
[ ] Student Health / Allina? Check the listed outpatient service exemptions
[ ] Exact member, CPT/HCPCS and setting checked against the service entry
[ ] Federal plan? Check service-specific requirements and member-card route
[ ] Behavioral health service? Use the behavioral health precert list

2. PICK THE RIGHT ROUTE
[ ] Aetna-reviewed medical service -> Availity: Authorization (Precertification) Add
[ ] Vendor route confirmed for this member, code, setting and date
  (EviCore, Carelon, Evolent, Tango, WellSky, ASH or iCare)
[ ] GR-68831 is a supplement only; service-specific initiation rules checked
[ ] Specialty drug, commercial -> Availity (Novologix) or fax 1-888-267-3277
[ ] Drug, Medicare Advantage -> 1-866-503-0857 / fax 1-844-268-7263
[ ] Louisiana provider IN THE CREDENTIALING PROCESS -> follow Aetna's
  online instruction: call the member-card precert number; do not use EDI
  (not a blanket restriction on all Louisiana providers)

3. PROVIDER AND SITE DETAILS
[ ] Requesting physician name, NPI, TIN, fax, participating status
[ ] Rendering provider and facility name, NPI, fax, participating status
[ ] Place of service matches where care will actually happen
[ ] Outpatient hospital? Document why an ASC or office won't work
  (site-of-service and MRI/CT site-of-care rules can apply)
[ ] Assistant/co-surgeon name and TIN, if any

4. CODES AND DATES
[ ] CPT/HCPCS codes with descriptions (drugs: include administration codes)
[ ] ICD-10 codes, primary first
[ ] Planned date of procedure
[ ] Inpatient > 24 hours? Clinical rationale for the admission

5. CLINICAL RECORD (what Aetna's form asks for)
[ ] Patient's symptoms
[ ] Clinical findings
[ ] Conservative management tried, with outcome and dates
[ ] Anticipated outcome of the proposed treatment
[ ] Supporting notes, imaging, labs attached, not just referenced
[ ] Criteria cited: Aetna Clinical Policy Bulletin, or NCD/LCD for
  Medicare Advantage
[ ] Service-specific Aetna precert form completed, if one exists

6. AFTER YOU SUBMIT
[ ] Reference number recorded: ______________
  (Aetna: a tracking number is not an approval)
[ ] If pended: Precertification Information Request Form (GR-68831)
  attached to the case on Availity, or faxed to FaxHub 1-833-596-0339
  (clinical information only)
[ ] Decision follow-up date on the calendar: ___________
[ ] Approval valid 6 months if eligibility and coverage don't change
  (unless the decision says otherwise). Service date inside window.

If a request pends and you're faxing records, a one-line cover note tied to the reference number keeps the fax from becoming a stray document:

TO: Aetna Precertification Department (FaxHub 1-833-596-0339)
FROM: [Practice name] | [Contact name] | Phone [number] | Fax [number]
DATE: [Date]
RE: Clinical information for pended precertification request

Reference number: [Aetna reference number]
Member name / Aetna member ID: [Name] / [ID]
Member date of birth: [DOB]
Requesting physician / NPI: [Name] / [NPI]
Service / CPT-HCPCS: [Description] / [Codes]
Planned date of service: [Date]

Enclosed ([#] pages):
[ ] Precertification Information Request Form (GR-68831) or service-specific form
[ ] Office notes dated [dates]
[ ] Imaging / labs dated [dates]
[ ] Conservative treatment records dated [dates]
[ ] Letter of medical necessity

This fax contains clinical information only for the reference number above.

If the service is unusual or high-cost, add a letter of medical necessity. The Aetna medical necessity letter template is built around Clinical Policy Bulletin criteria.

How Long Aetna Takes to Decide a Prior Authorization

The legal deadline depends on the plan type. Aetna's forms don't publish a single turnaround time.

The CMS Interoperability and Prior Authorization final rule sets these seven-day/72-hour decision periods for affected non-drug prior authorizations; it excludes drug PA and QHP issuers on federal exchanges from that timeframe requirement. MA Part B drug initial decisions instead follow 42 CFR 422.568 (72 hours standard) and 42 CFR 422.572 (24 hours expedited). Other drug benefits have their own program-specific rules; verify those rather than borrowing the non-drug periods. For ERISA group health plans, the Department of Labor claims procedure rule requires a pre-service decision within 15 days and an urgent-care decision within 72 hours. Colorado sets its own deadlines for prescription drug requests on fully insured Colorado contracts, and Aetna's list says it follows them.

Three Aetna rules from the 2026 list affect the calendar:

• Approvals last six months if the member's eligibility and plan coverage for the service don't change, unless the decision says otherwise. This applies in all states.
• Emergencies don't need precertification, with two exceptions. An emergency visit that leads to an inpatient admission must be reported within two business days. A procedure that needs precertification and isn't done on the same day as the ER visit still needs it.
• Maternity stays need precertification only past the standard length of stay: more than three days for a vaginal delivery or more than five days for a cesarean.

If you're waiting on a decision, the prior authorization status check call script covers what to ask and what to write down.

Why Aetna Precertification Requests Stall or Get Denied

Most avoidable problems come from routing and missing records, not clinical disagreement. These are the ones Aetna's own documents warn about.

• Starting with the wrong form. GR-68831 cannot initiate a case; it supports an existing reference number. A service-specific initiation form, such as the commercial specialty-medication fax request, follows its own instructions.
• Assuming a vendor applies to every member. Check the exact member, CPT/HCPCS, setting and service entry before deciding whether precertification is needed or EviCore is the delegate. Student Health/Allina outpatient exemptions, federal-plan routes and setting exceptions can change the answer.
• Treating the tracking number as an approval. Aetna's precertification lists page says the tracking number "isn't an approval."
• Site of care. Some fully insured and opted-in self-funded members need precertification just because a listed procedure is in an outpatient hospital. Examples are septoplasty (30520) and cystourethroscopy (52000). Some members also have MRI and CT site-of-care rules. Aetna's generic form asks you to justify an outpatient hospital setting with specific risk factors.
• Sending part of the record. The list says missing records can delay the review or lead to a denial. Attach the notes, imaging, and treatment history the questionnaire asks for.
• Using last year's vendor route. Florida Medicare home health moves from Carelon to Aetna on January 1, 2027. Nevada Medicare home health and SNF reviews moved to Tango and WellSky on September 1, 2026.

If the request still comes back denied, the work moves from the form to the appeal. That's covered in the Aetna prior authorization denial appeal guide and the Aetna prior authorization appeal template. For the denial reasons that show up across payers, see the complete prior authorization denial guide.

When an Aetna Prior Authorization Is Denied, Draft the Appeal With Muni

Muni Appeals picks up after the denial. Upload the Aetna denial notice and the clinical record. Muni drafts the appeal letter against the Clinical Policy Bulletin or NCD the denial cites, flags the deadline on the notice, and lists the attachments to include. Your physician reviews and signs it, and your team files it through the route Aetna gives.

Muni doesn't submit precertification requests or decide medical necessity. It handles the drafting after a denial, which is usually where staff time goes. If you're comparing tools for that work, see how Muni compares with EZAppeal.

Start 3 Free Appeals

Frequently Asked Questions

Where do I find the Aetna prior authorization form PDF?

Aetna's precertification forms are on its health care professional forms page, grouped into medical, behavioral health, Medicare, specialty pharmacy, oral surgery, and pharmacy sections. GR-68831 cannot start a request; follow its Availity/phone workflow and attach it to the existing case when requested. Other service-specific forms can initiate review: the commercial specialty-medication form directs a completed fax with clinical records to 1-888-267-3277.

What is the Aetna precertification fax number?

For clinical records on an existing request, Aetna's FaxHub number is 1-833-596-0339 for both commercial and Medicare. It accepts clinical information only. Specialty drug requests go to 1-888-267-3277 for commercial plans and 1-844-268-7263 for Medicare Advantage. EviCore-reviewed services use EviCore's fax numbers, such as 1-800-540-2406 for imaging and cardiology.

What is the Aetna precertification phone number?

Call 1-888-632-3862 for commercial plans and 1-800-624-0756 for Medicare and HMO plans. Both numbers are in Aetna's 2026 precertification list and on the Precertification Information Request Form. If the member's ID card shows a different number, use the number on the card.

Can I submit an Aetna prior authorization on Availity?

Yes. Aetna names Availity as the main route for most requests. Use the Authorization (Precertification) Add transaction and answer the clinical questionnaire if one appears. Commercial specialty drug requests also go through Availity, using Novologix. Practices can register at availity.com/aetnaproviders.

Does Aetna use EviCore for prior authorization?

Yes, when the exact plan, service code and setting fall within an EviCore program. The list names EviCore at 1-888-622-7329 for applicable imaging, cardiology, sleep, pain, PVD and radiation requests, but preserves the Student Health/Allina outpatient exemptions, setting exclusions and federal-plan exceptions described above. Applicable Florida Medicare oncology goes to Evolent; listed Medicare Advantage home-health/SNF programs in New Jersey, New York, Pennsylvania and West Virginia use EviCore. Verify the exact entry before routing.

How far in advance should I submit an Aetna prior authorization?

Aetna asks for precertification requests at least two weeks before the service. That leaves time for a pended request, a records request, or a vendor reroute before the service date.

How long is an Aetna prior authorization approval valid?

Six months, if the member's eligibility and coverage for the service don't change. The decision notice can set a different period. Aetna says the six-month rule applies in all states.

Is the Aetna prior authorization form the same for Medicare Advantage?

No. Medicare Advantage medical requests use the Standard Organization Determination Information Request Form (GR-69463). Medicare Advantage drug requests use the Medicare drug fax forms. Aetna reviews Medicare Advantage requests against CMS NCDs and LCDs first, then its Clinical Policy Bulletins.

This guide reflects Aetna's participating provider precertification list updated November 1, 2026, and the Aetna forms linked above as of November 2026. Aetna usually updates its list in January and July, and vendor delegations, phone numbers, and fax numbers change. Confirm the route against the member's ID card, Availity, and the current list before you submit. This information is for administrative and billing purposes and is not medical or legal advice.