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.
Authorization to Release PHI (English/Spanish)
Authorization to Release Psychotherapy Notes (English/Spanish)
PHI Access Request (English/Spanish)
Removal of Authorization Previously Given (English/Spanish)
Request for an Accounting Disclosures of PHI (English/Spanish)
Notice of Privacy Practices (English/Spanish)
Appointment of Representative Form
Behavioral Health Prior Authorization Form
Prescription Drug Mail Order Form (English & Español)
Coverage Redetermination Request Form
Medicare Part D Prescription Claim/Reimbursement Form (English & Español)
Member Advisory Committee Application