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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 $1.99 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.

Submission checklist

○Your name, date of birth, member ID

○Your situation described (min 50 chars · 0 entered)

✓Insurer fax number

○AI appeal letter generated & reviewed

1 of 4 checks complete

Prior Authorization Request

1. Your Doctor's Information(optional — helps strengthen your appeal)

Doctor Name

NPI (10 digits)

Practice / Clinic Name

Doctor Phone

Doctor Fax

2. Your Information & Insurance

Patient Name *

Date of Birth * (MM/DD/YYYY)

Member ID *

Group Number

3. Clinical Details(optional — include if known)

ICD-10 Code (if known)

Diagnosis (if known)

CPT Code (if known)

Denied Treatment / Procedure

Urgency

4. Your Medical Situation

Describe your situation in your own words *(min 50 chars)0/10000

Explain why you need this treatment, what your doctor has recommended, and what happened when the insurer denied it. The more detail you provide, the stronger your appeal.

5. AI Appeal Letter

Privacy notice: Clicking “Generate with AI” sends your description to OpenAI to draft your appeal letter. Do not include sensitive information beyond what is medically relevant.

6. Submission Method

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