Prior authorization to Aetna

Aetna applies InterQual clinical criteria to most medical necessity reviews. Citing the specific InterQual criteria or peer-reviewed clinical guidelines in your notes — rather than a general summary — meaningfully improves first-pass approval rates. Urgent requests qualify for an expedited review track. A valid NPI is required on every submission; missing or invalid NPIs are among the most common reasons for immediate rejection.

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Aetna

CommercialMedicare Advantage

PA Fax: +18882324535
PA Phone: +18008722583
Standard turnaround: 3 business days
Urgent turnaround: 72 hours

Aetna requires NPI and member ID on all PA requests. Urgent requests expedited within 72 hours.

Aetna provider portal →

What you'll need

★ PortalFaxPhonePortal preferred

☐Ordering provider NPI (required on every request)
☐Patient member ID
☐ICD-10 diagnosis code(s)
☐CPT procedure code(s)
☐Clinical notes establishing medical necessity
☐Auth number from original request (appeals only)
☐Treating provider contact information

▶Common denial reasons

⚠Lack of medical necessity — include clinical guidelines supporting the request
⚠NPI missing or invalid
⚠Procedure classified as experimental or investigational
⚠Failure to use preferred alternative when one exists

Verified 2026-05-20. Check payer site for current rules →

From $2.99 per submission

PA Agent requires an account so you can track submissions, record outcomes (approved/denied), and pre-fill appeals automatically. It's free to join.

You can preview the form below — sign in before generating or submitting.

⬆ Import from CSVDownload template

Submission checklist

○Provider name, NPI, practice name

○Provider phone & fax number

○Patient name, DOB, member ID

○ICD-10, diagnosis, CPT, procedure

○Clinical notes (min 50 chars · 0 entered)

✓Fax destination number

○AI justification generated & reviewed

1 of 7 checks complete

Prior Authorization Request

1. Provider Information

Provider Name *

NPI * (10 digits)

Practice Name *

Provider Phone *

Provider Fax *

2. Patient & Insurance

Patient Name *

Date of Birth * (MM/DD/YYYY)

Member ID *

Group Number

💬 Patient notifications: add the patient's email below and they'll automatically receive an email when you record the insurer's decision on the tracking page — no phone call needed.

Patient Email (for outcome notifications)

Patient Phone (for future SMS notifications)

3. Clinical Details

ICD-10 Code *

Diagnosis Description *

CPT Code * (5 digits)

Procedure Description *

Urgency

4. Clinical Notes

Provider notes & supporting rationale *(min 50 chars)0/10000

5. AI Clinical Justification

PHI notice: Clicking “Generate with AI” sends clinical notes and diagnosis to OpenAI for processing. Do not include information beyond what is clinically necessary. Review your organization's policies before submitting patient data to third-party AI services.

6. Submission Method

✓ Pre-filled with Aetna's PA fax number.